J.Jpn. Surg. Soc.. 123(3): 240-246, 2022

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LOCAL CONTROL METHOD FOR LOCALLY ADVANCED RECTAL CANCER

The difference in treatment paradigms between the West and Japan for locally advanced rectal cancer (LARC) is the result of a difference in priorities. In the West, the main focus of treatment development has been on improving the integrity of total mesorectal excision (TME) through preoperative treatment rather than on the lateral region. On the other hand, in Japan, the concept of extended lymph node dissection has been developed, leading to a unique surgical technique of adding lateral lymph node dissection (LLND) to TME. LLND has been accepted as the standard treatment for LARC because of its favorable local recurrence rate. The JCOG0212 trial was designed to scientifically verify the significance of this approach. The findings of the primary analysis clarified the position of LLND in patients without obvious lateral lymph node metastasis on preoperative imaging and supported the validity of TME plus LLND as the standard surgery in Japan for LARC. On the other hand, high-risk patients who cannot be cured by LLND plus postoperative adjuvant chemotherapy alone have also been identified. In the future, we hope to develop a multidisciplinary treatment that optimizes the indications for LLND and preoperative treatment according to the risk of recurrence.

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