The incidence of LPLN metastasis is high even after preoperative CRT, and LPLD might improve local control and survival of patients with LPLN metastasis in advanced low rectal cancer treated with preoperative CRT.

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Laparoscopic surgery for colorectal cancer is technically more demanding in Japanese obese II patients than in nonobese or obese I patients. Special care is required because of the increased risk of developing postoperative complications.

Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.