Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2877
Peer-review started: January 7, 2020
First decision: February 19, 2020
Revised: April 17, 2020
Accepted: April 28, 2020
Article in press: April 28, 2020
Published online: June 7, 2020
Lateral lymph node metastasis is one of the leading causes for local recurrence in patients with advanced mid or low rectal cancer. The addition of lateral lymph node dissection (LLND) after neoadjuvant chemoradiotherapy (NCRT) remains a controversial topic.
There is a lack of consensus leading to an East (mainly Japan)-West division concerning the management of lateral lymph nodes after NCRT associated with lower rectal cancer. There are few data regarding surgical outcomes of total mesorectal excision (TME) plus LLND after NCRT.
The main aim of this study was to investigate the surgical outcomes of TME plus LLND, and the possible risk factors for lateral lymph node metastasis after NCRT.
We performed an observational study and enrolled patients who underwent TME plus LLND. Information regarding the clinicopathologic features and clinical outcomes was collected and analyzed. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in the NCRT patients.
Lateral lymph node metastasis can be found in lower rectal cancer patients with enlarged lymph node size. Advanced T stage, poor differentiation type, and short axis ≥ 7 mm were statistically significant risk factors associated with LLN metastasis.
Preoperative chemoradiotherapy is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater lateral lymph node short axis diameter, poorer histological differentiation or advanced T stage. Selective LLND for NCRT patients can have a favorable oncological outcome.
Larger prospective multicenter clinal studies need to be performed so that standard managements regarding lateral lymph nodes in rectal cancer can be established.