Lateral Pelvic Node Dissection for Advanced Rectal Cancer: Current Debates and Use of the Robotic Approach

Abstract

Lateral lymphatic spread in rectal cancer has been described since the early 1900s and its clinical importance is well recognized. However, the treatment of lateral pelvic node (LPN) involvement in rectal cancer is still controversial and varies according to surgeons and institutions. Japanese surgeons have pioneered lateral pelvic node dissection (LPND) to reduce local and even systemic failure after rectal cancer surgery. On the other hand, in western countries, preoperative chemoradiation (CRT) and total mesorectal excision (TME) is regarded as the standard treatment. It is primarily due to technical difficulty and higher morbidity of LPND as well as believing LPN involvement as systemic rather than regional disease. For the same reasons, even in the era of minimally invasive surgery, laparoscopic TME plus LPND is rarely conducted. Recently, a surgical robot (da Vinci Surgical System) emerged and gained attractions in complicated pelvic surgeries with its mechanical advantages of endo-wrist function of the instruments, three-dimensional magnified vision and high fidelity of precision, etc. Consequently, TME with LPND could be one of the best indications for robotic approach. Unfortunately, little robotic TME and LPND has been attempted and its clinical efficacy has not been fully understood, so far. Therefore, further studies should be undertaken to prove the role of LPND and its robotic use for the treatment of advanced low rectal cancer.