The Role of Lateral Pelvic Lymph Node Dissection in Middle and Lower Rectal Cancer (Stage II or III): A Literature Review

Abstract

Lateral lymph node dissection and its inclusion in the treatment of rectal cancer is a controversial issue, with great differences, especially between Eastern and Western countries. Studies try to highlight the superiority of resection of these lymph nodes compared to simple mesorectal resection in terms of local recurrence of the disease, the overall survival of patients, and additional postoperative complications. In this study, the modern literature was reviewed, with the ultimate goal of clarifying the exact importance of lateral lymph node dissection, in terms of oncological outcome in patients with cancer of the middle and lower rectum, by studying the involvement of this lymph node dispersion in terms of local recurrence and overall survival of patients with rectal cancer. This review was carried out using electronic databases, including PubMed, Embase, and MEDLINE, with studies dating back to the last decade. Of the 31 studies that were eventually included in the final review, there is no statistically clear superiority and real benefit from lymph node resection beyond the lymph nodes of the mid-rectum. European guidelines are set against lateral lymph node dissection, except for lymph nodes that show suspicious features on preoperative imaging. In contrast, in Eastern countries, total mesorectal excision (TME) with extensive simultaneous resection of the lateral pelvic lymph nodes (LPLNs) is the protocol followed. Recent studies focus on the subcategory of patients with non-responsive to adjuvant therapy, lateral lymph nodes, in which the ultimate benefit of extensive lymph node dissection is explored. The decision to join the TME procedure for the removal of the LPLNs is a subject of intense research. There are no data on the criteria for determining these lymph nodes as an increased risk of metastatic outbreaks. Despite the great clinical and research interest worldwide nowadays, the resection of LPLNs remains a controversial issue of debate, with intense disagreements according to geographical area, while the existence of additional studies is necessary to come to final conclusions.

Keywords: lateral pelvic wall lymph node dissection; neoadjuvant chemoradiotherapy; pelvic lymph nodes; rectal cancer; review of literature.

Figure 1. Flowchart