Abstract
Lateral lymph node dissection for rectal cancer was introduced in the 1950s, but the procedure was later abandoned in the West because of high rates of associated morbidity and intraoperative bleeding. In Japan, however, lateral lymph node dissection is still the standard form of surgery for lower rectal cancer, and can be either prophylactic or therapeutic, depending on whether lateral pelvic lymph node metastasis is clinically absent or present, respectively. Because some patients with lateral lymph node metastasis can survive for more than 5 years after lateral lymph node dissection, the procedure should be attempted if technically feasible. However, the use of prophylactic lateral lymph node dissection remains controversial, even in Japan. Therefore, a randomized controlled trial (the JCOG0212 trial) to confirm the efficacy of prophylactic lateral lymph node dissection has been initiated. It is anticipated that the JCOG0212 trial will clarify the indications for prophylactic lateral lymph node dissection, and prove to be an important milestone in research on rectal cancer surgery.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
UICC. TNM classification of malignant tumours. 7th ed. West Sussex: Wiley-Blackwell; 2009.
Gerota D. Die Lymphgefesse des Rectums und Anus. Arch Anat Physiol. 1895:240–56.
Senba Y. An anatomical study of the lymphatic system of the rectum (in Japanese). J Fukuoka Med Coll. 1927;20:1213–68.
Sauer I, Bacon HE. A new approach for excision of carcinoma of the lower portion of the rectum and anal canal. Surg Gynecol Obstet. 1952;95(2):229–42.
Stearns Jr MW, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum. 1959;2(2):169–72.
Bacon HE, Dirbas F, Myers TB, Ponce De Leon F. Extensive lymphad enectomy and high ligation of the inferior mesenteric artery for carcinoma of the left colon and rectum. Dis Colon Rectum. 1958;1(6):457–64; discussion 464–455.
Koyama Y, Moriya Y, Hojo K. Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum–significant improvement of survival rate and decrease of local recurrence. Jpn J Clin Oncol. 1984;14(4):623–32.
Moriya Y, Sugihara K, Akasu T, Fujita S. Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer. 1995;31A(7–8):1229–32.
Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. 2nd ed. Tokyo: Kanehara; 2009.
Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. 1st ed. Tokyo: Kanehara; 1997.
Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, Sugihara K. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52(4):567–76. doi:10.1007/DCR.0b013e3181a1d994.
Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49(11):1663–72. doi:10.1007/s10350-006-0714-z.
Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, Japanese Society for Cancer of the C, Rectum. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255(6):1129–34. doi:10.1097/SLA.0b013e3182565d9d.
Fujita S, Yamamoto S, Akasu T, Moriya Y. Prognostic factors of rectal cancer patients with lateral pelvic lymph node metastasis. Hepatogastroenterology. 2012;59(120):2494–7. doi:10.5754/hge12153.
Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert P. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;8:583–96.
Fujita S, Yamamoto S, Akasu T, Moriya Y. Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis. 2009;24(9):1085–90. doi:10.1007/s00384-009-0704-4.
Akasu T, Iinuma G, Takawa M, Yamamoto S, Muramatsu Y, Moriyama N. Accuracy of high-resolution magnetic resonance imaging in preoperative staging of rectal cancer. Ann Surg Oncol. 2009;16(10):2787–94. doi:10.1245/s10434-009-0613-3.
Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, Ohue M, Fujii S, Shiozawa M, Yamaguchi T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13(6):616–21. doi:10.1016/S1470-2045(12)70158-4.
Kobayashi A, Fujita S, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu K, Ohue M, Fujii S, Kimura H, Moriya Y. Urinary dysfunction after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212). Amsterdam: European Cancer Congress 2013; 2013.
Saito S, Fujita S, Mizusawa J, Saito N, Kinugasa Y, Akazai Y, Fujii S, Kanemitsu K, Akasu T, Moriya YM. Sexual dysfunction after rectal cancer surgery – the results from a prospective randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Amsterdam: European Cancer Congress 2013; 2013.
Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10(11):1053–62. doi:10.1016/S1470-2045(09)70224-4.
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the C, Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17(1):1–29. doi:10.1007/s10147-011-0315-2.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag London
About this chapter
Cite this chapter
Fujita, S., Kotake, K. (2015). Lateral Lymph Node Dissection for Rectal Cancer. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_13
Download citation
DOI: https://doi.org/10.1007/978-1-4471-6609-2_13
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-6608-5
Online ISBN: 978-1-4471-6609-2
eBook Packages: MedicineMedicine (R0)