Lateral lymph node dissection for rectal cancer

Abstract

Lateral lymph node dissection for rectal cancer was introduced in the 1950s, but the procedure was later abandoned in the West because of high rates of associated morbidity and intraoperative bleeding. In Japan, however, lateral lymph node dissection is still the standard form of surgery for lower rectal cancer, and can be either prophylactic or therapeutic, depending on whether lateral pelvic lymph node metastasis is clinically absent or present, respectively. Because some patients with lateral lymph node metastasis can survive for more than 5 years after lateral lymph node dissection, the procedure should be attempted if technically feasible. However, the use of prophylactic lateral lymph node dissection remains controversial, even in Japan. Therefore, a randomized controlled trial (the JCOG0212 trial) to confirm the efficacy of prophylactic lateral lymph node dissection has been initiated. It is anticipated that the JCOG0212 trial will clarify the indications for prophylactic lateral lymph node dissection, and prove to be an important milestone in research on rectal cancer surgery.