Abstract: Controversy and consensus on routine No.253 lymph node dissection for low rectal cancer        YAN Su, MA Xin-fu, ZHAO Kang, et al. Department of Gastro-colorectal Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
Corresponding author: YAN Su, E-mail：yansuxining@outlook.com
Abstract    There are some different views between the East and the West on whether the low rectal cancer is routinely performed with No.253 lymph node dissection or not. Western scholars emphasize that total mesorectal excision（TME）and the integrity of the mesorectum are the keys to the radical operation. Japanese and Chinese scholars emphasize not only total mesorectal excision，but also the lymph nodes dissection（LND）at the root of inferior mesenteric artery（No.253 lymph nodes）. In recent years，the view of No.253 lymph node dissection has been unified. If No.253 lymph nodes metastasis is suspected，neoadjuvant chemotherapy is recommended firstly，or quick-freezing examination is performed during operation. If No.253 lymph node metastasis are confirmed，No.253 lymph node dissection is recommended. Nevertheless， if No.253 lymph node is negative, No.253 lymph node dissection is not performed，because it is easy to damage the lumbar splanchnic nerve and the inferior mesenteric plexus when No.253 lymph node is been cleaning，which will cause postoperative genitourinary dysfunction. At present，most scholars think that No.253 lymph node dissection is not routinely performed for low rectal cancer within T2 stage, but for low rectal cancer above T3 stage, if preoperative examination suspected No.253 lymph node metastasis, it is more emphasis on neoadjuvant chemoradiotherapy combined with TME and D3 radical operation including No.253 lymph node dissection.

Key words: low rectal cancer, No. 253 lymph nodes, inferior mesenteric artery, controversy, consensus

摘要： 低位直肠癌是否常规行No.253淋巴结清扫，目前仍存在诸多争议，且东西方观点有所不同。西方学者更强调全直肠系膜切除（TME），保证直肠系膜的完整性是手术根治的关键，良好的TME手术质量可降低局部复发率。对于T2以上的低位直肠癌日本学者和我国学者除了强调全直肠系膜切除外，还注重对肠系膜下动脉根部淋巴结（即No.253淋巴结）的清扫（D3根治术）。近年来，低位直肠癌是否常规行No.253淋巴结清扫观点趋于统一：如怀疑No.253淋巴结转移，建议行新辅助化疗，或术中行快速冰冻病理学检查，如证实No.253淋巴结转移则进行彻底的清扫。对于分期在T2以内的低位直肠癌，若术前检查和术中探查No.253淋巴结阴性则不作为低位直肠癌的常规清扫范围，因为在清扫No.253淋巴结时很容易损伤腰内脏神经和肠系膜下神经丛，造成术后泌尿生殖功能障碍。多数学者认为对于T2以内的低位直肠癌不常规行No.253淋巴结清扫，而对于T3以上的低位直肠癌如术前检查怀疑No.253淋巴结发生转移，则更强调新辅助放化疗联合TME及行No.253淋巴结清扫的D3根治术。

关键词: 低位直肠癌, No.253淋巴结, 肠系膜下动脉, 争议, 共识