Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management

Abstract

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer are described in this review. Magnetic resonance imaging (MRI) is recommended for the diagnosis of LPLN metastasis. A LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications; therefore, LPLD may not be appropriate for cases that are less likely to have LPLN metastasis. Radiation therapy (RT) and chemoradiation therapy (CRT) have limited effects in cases with suspected LPLN metastasis, but a combination of preoperative CRT and LPLD may improve the treatment outcome. Thus, RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

“…However, scientific literature does not express consensus on radiological criteria to be adopted for PALND [15]. Moreover, in different cases, pathological PALNM positivity did not align with the radiological suspicion [5,[10][11][12][13][14][15][16][17]29,30]. Therefore, several PALNDs could collect pathologically negative PALNs for malignancy [5,[10][11][12][13][14][15][16][17]29,30].…”

“…Moreover, in different cases, pathological PALNM positivity did not align with the radiological suspicion [5,[10][11][12][13][14][15][16][17]29,30]. Therefore, several PALNDs could collect pathologically negative PALNs for malignancy [5,[10][11][12][13][14][15][16][17]29,30]. For the above mentioned reasons, we only took into account patient populations with pathologically positive PALNMs, in order to recover long-term outcomes reducing the bias.…”

Morphological characteristics of lateral pelvic lymph nodes in locally advanced lower rectal cancer: A retrospective study

“…Most studies on the diagnosis of LPLN metastases in LALRC are primarily size‐related analyses; however, some have used morphological criteria. 11 , 12 , 20 , 21 Akasu et al used criteria such as an irregular border, mixed signal intensity, and the presence of a high‐intensity nodule within the lymph node on MRI. 21 Matsuoka et al reported that LPLNs with an “ovoid shape” tend to be metastasis positive, without analysis using aspect ratio criteria.…”

“…To our knowledge, there are no previous reports on the aspect ratios of LPLNs in LALRC. Most studies on the diagnosis of LPLN metastases in LALRC are primarily size‐related analyses; however, some have used morphological criteria 11,12,20,21 . Akasu et al used criteria such as an irregular border, mixed signal intensity, and the presence of a high‐intensity nodule within the lymph node on MRI 21 .…”

Open sidewall excision for recurrent rectal cancer with gluteal flap reconstruction – a video vignette

“…Peristomal hernia is a common complication of end colostomy; its incidence varies from 16% to 57% [5,6].…”