Abstract:

Significance of lateral lymph node dissection in rectal cancer after neoadjuvant chemoradiotherapy        LIU Qian，WANG Xi-shan. Department of Colorectal Surgery, National Cancer Center & National Clinical Research Center for Cancer & Cancer Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021，China
Corresponding author：WANG Xi-shan，E-mail：fcwpumxh@163.com
Abstract    Lateral lymph node metastasis is an important pathway for metastasis of middle and low rectal cancer，and it is also a major factor leading to recurrence of rectal cancer. The treatment strategy for lateral lymph node metastasis of rectal cancer has been a hot topic in the field of surgery. Western scholars oppose lateral lymph node dissection，and neoadjuvant and adjuvant chemoradiotherapy are the main methods for the treatment of lateral lymph node metastasis. For patients with swollen lateral lymph node after neoadjuvant therapy，if only TME surgery is performed， it will lead to positive lymph node residue and cannot achieve R0 resection. For this situation，how to choose optimal targeted treatment strategy according to the specific condition，and the LLND for R0 resection is of great significance for further reducing local recurrence，improving prognosis and improving patients' quality of life.

Key words: rectal cancer, lateral lymph node dissection (LLND), neoadjuvant chemoradiotherapy, total mesorectal excision (TME)

摘要：

侧方淋巴结转移是中低位直肠癌转移的重要途径，也是导致直肠癌复发的主要因素。直肠癌侧方淋巴结转移的治疗策略一直是外科领域争论的热点话题。西方学者主张将新辅助放化疗作为治疗侧方淋巴结转移的主要方法，但新辅助治疗并不能完全消除转移至侧方的淋巴结，对于新辅助治疗后仍然存在侧方淋巴结肿大的病例，如果单纯行全直肠系膜切除，势必导致阳性淋巴结残留而无法达到R0切除。对于这部分病例，如何根据具体病情，合理选择治疗策略，有针对性地进行侧方淋巴结清扫以争取R0切除，对进一步降低局部复发，改善预后，提高病人生活质量具有重要意义。

关键词: 直肠癌, 侧方淋巴结清扫, 新辅助治疗, 全直肠系膜切除