Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive Surgery

Abstract

The lateral lymph node dissection (LLND) is still a subject of great debate as to the appropriate treatment for patients with mid to low advanced rectal cancer. The guidelines of the Japanese Society for Cancer of the Colon and Rectum recommend a LLND for patients with T3/4 rectal cancer below the peritoneal reflection. However, in most Western countries, a routine LLND is not recommended unless a node or nodes are clinically suspicious for metastasis. Even after preoperative chemoradiotherapy (CRT), an 8% to 12% lateral pelvic recurrence was noted. The size of the lateral lymph node and responsiveness to preoperative CRT should be the main factors for selecting appropriate patients to undergo a LLND. In addition, from the recent literature, a laparoscopic LLND is safe and oncologically feasible and might have some advantages in short-term outcomes.

Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

“…An appropriate balance between these two, led by a suitable indication of malignancy by radiologists and active discussion by multidisciplinary teams (MDT) may help select the appropriate 'high-risk' patients who can benefit from an LLND, while sparing those for whom it is unnecessary. LLNs are still sparingly investigated, resulting in limited knowledge and awareness [2,16,17]. Accurate diagnosis of malignant LLNs remains therefore a challenging subject, even though subsequent treatment decisions for these patients are primarily based on the assessment of preoperative imaging [9,10,16,18,19].…”

Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

“…Despite increasing evidence for the importance of LLNs, international guidelines are scarce (8,9,(11)(12)(13)(14)(15)(16)(17). For select patients, (C)RT and TME may be insufficient and this group might benefit from a lateral lymph node dissection (LLND), during which all lymphatic tissue is removed from the lateral compartments.…”

Laparoscopic Extraperitoneal Approach for Lateral Pelvic Node Dissection in Rectal Cancer: Techniques and Short-Term Outcomes

“…10 These studies reported that the surgical safety and oncological results of laparoscopic surgery are comparable to those of open surgery. 11,12 Therefore, most LPND is currently performed with laparoscopy. In addition, advances in laparoscopic cameras, such as high resolution and magnified 3-dimensional (3D) vision, helped to clarify the complex structures of blood vessels and nerves around LPLN, thereby reducing the risk of damage.…”