Oncological Outcomes of Lateral Lymph Node Dissection (LLND) for Locally Advanced Rectal Cancer: is LLND Alone Sufficient?

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2020 Sep 23

PMID 32965528

Citations 4

Authors

Atsushi Ishibe

Jun Watanabe

Yusuke Suwa

Shinsuke Suzuki

Kazuya Nakagawa

Hirokazu Suwa

Mayumi Ozawa

Mitsuyoshi Ota

Shoichi Fujii

Hideyuki Ike

Yasushi Ichikawa

Itaru Endo

Affiliations

Soon will be listed here.

Abstract

Background: Lateral lymph node dissection (LLND) has been considered as the standard treatment strategy for locally advanced lower rectal cancer in Japan. Controversy remains around whether all patients require LLND. This study aims to examine the long-term outcomes of patients in which LLND was performed and clarify the value of LLND.

Method: Consecutive 458 patients with lower rectal cancer who underwent total mesorectal excision (TME) plus LLND from 1992 to 2012 were included. The long-term outcomes and risk factors for recurrent in patients performed TME + LLND were examined. We assessed the impact of LLND on survival using an estimated therapeutic index.

Results: The incidence of LLNM was 15.5%. The 5-year RFS and OS rates of patients with LLNM were 40.9% and 47.7%, while patients without LLNM had a good prognosis. The 5-year local recurrence (LR) rate was 9.2%, and independent risk factors for LR were T4 and LLNM. The LR rate of patients with LLNM was high (22.8%). The LLNM rate of the groups with 0, 1, 2, 3, or 4 risk factors (male, tumor location < 4 cm from anal verge, T4, and MLNM) was 3.8%, 9.2%, 18.1%, and 50.0%. The 5-year OS of the groups was 96.2%, 86.1%, 69.7%, and 48.5%.

Conclusion: Although patients with locally advanced lower rectal cancer who received LLND had a good prognosis, LLND alone was insufficient to control local recurrence in patients with metastatic lateral nodes.

Citing Articles

Upfront surgery, neoadjuvant chemoradiotherapy, or neoadjuvant chemotherapy for rectal cancer with lateral lymph node metastasis: A multicenter MRI and lateral lymph node dissection study.

Miura T, Kawai K, Fujita H, Kazama S, Ueno H, Kinugasa Y Ann Gastroenterol Surg. 2025; 9(2):309-318.

PMID: 40046530 PMC: 11877350. DOI: 10.1002/ags3.12873.

Lateral pelvic lymph node dissection (LPLND) in the treatment of rectal cancer: current practice and evolving approaches in India.

Sharma A, Manohkaran S, Saklani A Tech Coloproctol. 2025; 29(1):55.

PMID: 39847153 PMC: 11759476. DOI: 10.1007/s10151-024-03081-4.

Long-term outcomes of S-1 and oxaliplatin neoadjuvant chemotherapy with total mesorectal excision and lateral lymph node dissection for rectal cancer.

Morohashi H, Sakamoto Y, Miura T, Kagiya T, Sato K, Tsutsumi S BMC Gastroenterol. 2024; 24(1):456.

PMID: 39695948 PMC: 11653903. DOI: 10.1186/s12876-024-03549-5.

Recurrence of rectal cancer on the pelvic sidewall after lateral lymph node dissection.

Takao M, Kawai K, Nakano D, Dejima A, Nakamori S, Natsume S Int J Colorectal Dis. 2024; 39(1):80.

PMID: 38806953 PMC: 11133041. DOI: 10.1007/s00384-024-04650-7.

Risk factors for lateral pelvic lymph node metastasis in patients with lower rectal cancer: a systematic review and meta-analysis.

Zeng D, Yang Z, Tan L, Ran M, Liu Z, Xiao J Front Oncol. 2023; 13:1219608.

PMID: 37746256 PMC: 10512344. DOI: 10.3389/fonc.2023.1219608.

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