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J.Jpn. Surg. Soc.. 121(3): 321-327, 2020
LAPAROSCOPIC LATERAL LYMPH NODE DISSECTION FOR RECTAL CANCER
In Japan, total mesorectal excision (TME) with prophylactic lateral lymph node dissection (LLND) without preoperative chemoradiotherapy (CRT) is standard treatment for clinical stage Ⅱ and Ⅲ low-rectal cancer. In contrast, CRT followed by TME is the standard treatment in Western countries. The JCOG0212 trial results indicated that lateral lymph node dissection ensured safety and preserved function and that prophylactic LLND contributed to a decrease in local recurrence rates. LLND or preoperative CRT alone is insufficient for local control of lateral compartments. One international multicenter trial demonstrated that TME and selective LLND with preoperative CRT in patients with enlarged lateral lymph nodes resulted in a reduction in lateral local recurrence rates. Thus, LLND has recently attracted increased attention in other countries. Laparoscopic LLND is becoming more widespread with improved understanding of surgical anatomy. It is also standardizing surgical quality with visual education through high-definition 3D images. A meta-analysis indicated that laparoscopic LLND had efficacy similar to conventional open surgery in terms of oncological outcomes and postoperative complications. It is expected that Japanese institutions will continue publishing the treatment results of LLND.
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