Selective Lateral Pelvic Lymph Dissection for Rectal Cancer

Excerpt

While the approach to curative treatment of low rectal cancer in the West has included preoperative radiation therapy (RT) followed by total mesorectal excision (TME), in Japan the “gold standard” traditionally has been TME with prophylactic dissection of the iliac and obturator lymph nodes without pelvic radiotherapy.1,2 The divergent philosophy in the approach to curative management of pelvic micrometastases was most recently highlighted by the JCOG 0212 trial, which evaluated the noninferiority of TME alone to TME with routine prophylactic lateral pelvic lymph node dissection (LPLND) among patients without clinical evidence of lateral pelvic lymph node metastasis.3 In this study, no patients received radiotherapy and the experimental treatment strategy of TME alone was inferior to the control strategy of TME + LPLND for local control. JCOG 0212 also demonstrated that lateral pelvic lymph node metastases occurred in 7% of patients who were radiographically node-negative within the lateral compartment before surgery and that the addition of LPLND resulted in a 5.2% absolute reduction in the rate of local failure.4 …