Minimally Invasive Lateral Pelvic Lymph Node Dissection

Abstract

Lateral pelvic lymph node dissection for treatment of advanced low rectal cancer has been predominantly performed in Japan, because of technical difficulties and higher incidence of surgical morbidities. In our institution, for patients with advanced low rectal cancer and synchronous clinically positive pelvic lateral nodes, treatment has included preoperative concurrent chemoradiation therapy (CCRT) followed by total mesorectal excision (TME). However, for patients with persistent enlargement of lymph node(s) even after CCRT, we have selectively performed lateral pelvic lymph node dissection. This procedure by a minimally invasive approach, either using laparoscopic or robotic technique, has been rarely reported. In this chapter, we present our lateral pelvic lymph node dissection approach for patients with clinically positive lateral node(s) after preoperative CCRT.