Abstract:

Selective lateral pelvic lymph node dissection for mid-low rectal cancer        WEI Ming-tian，WANG Zi-qiang. Department of Gastrointestinal Surgery，West China Hospital，Chengdu 610041，China
Corresponding author：WANG Zi-qiang，E-mail：wangzqzyh@163.com
Abstract  Lateral pelvic lymph node metastasis is not uncommon in patients with advanced mid-low rectal cancer，and is also the cause of lateral recurrence. The latter has been indicated to be the most common kind of local recurrences in Asian reports. Presence of enlarged lateral lymph nodes at presentation is an independent risk factor for lateral pelvic recurrence after chemoradiotherapy (CRT) and total mesorectal excision. Controversy exists between Asian and western countries with respect to the use of CRT and lateral lymph node dissection (LLND) in the management of mid-low advanced rectal cancer. Primary reports indicated that the combination of CRT and LLND was likely to be superior to either of the two strategies and provided more favourable local control and survival. So far，there is no consensus on the criteria to diagnose lateral lymph node metastases (LLNM) and the indication for selective LLND. More multicenter prospective cohort studies are warrant to address the issues, before we can provide better health care to the patients to improve their survival，as well as to avoid unnecessary LLND，which has been associated with more surgical complications and poorer quality of life.

Key words: mid-low rectal cancer, lateral pelvic lymph node dissection, neoadjuvant chemoradiotherapy

摘要：

侧方淋巴结转移是中低位进展期直肠癌的较常见转移方式，也是亚洲人群新辅助放化疗后常见的局部复发方式，侧方型复发预后极差。侧方肿大淋巴结是放化疗后侧方型复发的独立危险因素，东西方国家关于放化疗与侧方淋巴结清扫等在中低位进展期直肠癌中的应用存在巨大争议。有限的研究显示，对可疑淋巴结转移病人联合应用放化疗与选择性侧方淋巴结清扫，有望进一步降低局部复发率及改善病人生存。对未接受侧方淋巴结清扫的病人，理论上有必要进行更严密的随访，早期发现侧方型复发，及时手术治疗可能带来长期生存。目前，关于新辅助放化疗后侧方淋巴结转移的诊断及选择性侧方淋巴结清扫的手术指征尚无统一意见，亟需大宗病例前瞻性队列研究加以阐明，以进一步改善病人的局部复发及长期生存，并减少因过度手术带来的并发症及生活质量下降。

关键词: 中低位直肠癌, 侧方淋巴结清扫, 新辅助放化疗