J.Jpn. Surg. Soc.. 122(4): 375-378, 2021

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Feature topic

VALUE OF LATERAL PELVIC LYMPH NODE DISSECTION FOR RECTAL CANCER

In Japan, autonomic nerve-preserving lateral pelvic lymph node dissection (LPLND) was developed in the 1980s, and it has since become possible to avoid serious complications such as urinary or sexual dysfunction. For the validation of the effectiveness of LPLND, the JCOG0212 trial is important as the world’s only multicenter, randomized, controlled trial of LPLND. The 5-year recurrence-free survival rates were found to be 73.4％ and 73.3％, respectively. The noninferiority of mesorectal excision (ME) alone compared to ME with LPLND was not confirmed in the intent-to-treat analysis. ME with LPLND had lower local recurrence rates, especially in the lateral pelvis, compared to ME alone. Regarding the short-term results of LPLND, there was a significant increase in operation time and bleeding volume, although no significant differences were seen in perioperative complications, urinary dysfunction, and sexual dysfunction. LLND is useful as a safe procedure for local control. However, the JCOG0212 study also revealed its limitations, especially in the survival benefit. In Japan, there is an urgent need to establish a new standard treatment for advanced rectal cancer without relying solely on LPLND.

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