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Review
. 2020 Nov;107(12):1562-1569.
doi: 10.1002/bjs.11925. Epub 2020 Aug 8.

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

Affiliations
Review

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

J S Williamson et al. Br J Surg. 2020 Nov.

Abstract

Background: The management of lateral pelvic lymphadenopathy in low rectal cancer poses an oncological and technical challenge. Interpretation of the literature is confounded by different approaches to management in the East and West, and a lack of randomized data from which to draw accurate conclusions regarding the optimal approach. Recent collaboration between Eastern and Western centres has increased the standardization of care. Despite this, significant differences in international guidelines remain. The aim of this review was to appraise the available literature and propose a management algorithm.

Methods: A literature review of all relevant studies was performed to summarize the historical evidence, as well as establish the significance of clinically positive lateral pelvic sidewall nodes, and the role of neoadjuvant chemoradiotherapy and lateral pelvic node dissection. A management algorithm was developed based on this review of the literature.

Results: The management of pelvic sidewall lymphadenopathy in rectal cancer is non-standardized, with geographical differences. The mechanism of lateral lymphatic spread is well defined; the risk increases with lower tumour height and advanced T category. Existing data indicate that acceptable disease-free and overall survival can be achieved by neoadjuvant chemoradiotherapy with selective lateral pelvic node dissection.

Conclusion: Suspicious lateral pelvic sidewall nodes, particularly in the internal iliac chain, should be considered as resectable locoregional disease, and surgery offered for enlarged nodes that do not respond to neoadjuvant chemoradiotherapy.

Antecedentes: El tratamiento de las adenopatías en la pared pélvica lateral en el céncer de recto inferior plantea un desafío oncológico y técnico. La interpretación de la literatura es confusa por los diferentes abordajes en Oriente y Occidente y la falta de estudios aleatorizados a partir de los cuales extraer conclusiones precisas sobre cuél es el enfoque óptimo. La reciente colaboración entre los centros orientales y occidentales ha aumentado la estandarización del tratamiento. A pesar de ello, persisten diferencias significativas en las guías internacionales. El objetivo de esta revisión fue evaluar la literatura disponible y proponer un algoritmo terapéutico. MÉTODOS: Se realizó una revisión de la literatura de todos los estudios relevantes para resumir las evidencias existentes, así como para determinar la importancia de las adenopatías de la pared lateral pélvica clínicamente positivas, el papel de la quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, NCRT) y de la linfadenectomía pélvica lateral (lateral pelvic node dissection, LPND). Se desarrolló un algoritmo de tratamiento basado en esta revisión de la literatura.

Resultados: El tratamiento de las adenopatías de la pared lateral de la pelvis en el céncer de recto no esté estandarizado y sigue habiendo diferencias geogréficas. El mecanismo de la diseminación linfética lateral esté bien definido con un mayor riesgo en los tumores de recto inferior y con un estadio T avanzado. Los datos existentes demuestran que se puede obtener una supervivencia libre de enfermedad y global aceptables mediante NCRT con LPND selectiva. CONCLUSIÓN: Las adenopatías sospechosas en la pared lateral de la pelvis, en particular en la cadena ilíaca interna, deben considerarse enfermedad locorregional resecable y se debe ofrecer cirugía para los ganglios aumentados de tamaño que no responden a la NCRT.

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References

    1. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T et al.; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345: 638-646.
    1. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K et al.; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 2017; 266: 201-207.
    1. Ito M, Kobayashi A, Fujita S, Mizusawa J, Kanemitsu Y, Kinugasa Y et al.; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 2018; 44: 463-468.
    1. Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y et al.; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 2016; 42: 1851-1858.
    1. Ma P, Yuan Y, Yan P, Chen G, Ma S, Niu X et al. The efficacy and safety of lateral lymph node dissection for patients with rectal cancer: a systematic review and meta-analysis. Asian J Surg 2020; https://doi.org/10.1016/j.asjsur.2019.11.006 [Epub ahead of print].