Kim Min Jung, Oh Jae Hwan
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Cancer Research Institute, Seoul National University, Seoul, Korea.
Ann Coloproctol. 2018 Oct;34(5):229-233. doi: 10.3393/ac.2018.10.26. Epub 2018 Oct 31.
The lateral lymph node dissection (LLND) is still a subject of great debate as to the appropriate treatment for patients with mid to low advanced rectal cancer. The guidelines of the Japanese Society for Cancer of the Colon and Rectum recommend a LLND for patients with T3/4 rectal cancer below the peritoneal reflection. However, in most Western countries, a routine LLND is not recommended unless a node or nodes are clinically suspicious for metastasis. Even after preoperative chemoradiotherapy (CRT), an 8% to 12% lateral pelvic recurrence was noted. The size of the lateral lymph node and responsiveness to preoperative CRT should be the main factors for selecting appropriate patients to undergo a LLND. In addition, from the recent literature, a laparoscopic LLND is safe and oncologically feasible and might have some advantages in short-term outcomes.
对于中晚期直肠癌患者的合适治疗方法，侧方淋巴结清扫术（LLND）仍是一个备受争议的话题。日本结直肠癌学会的指南建议，对于腹膜反折以下的T3/4期直肠癌患者行侧方淋巴结清扫术。然而，在大多数西方国家，除非临床上怀疑有淋巴结转移，否则不建议常规行侧方淋巴结清扫术。即使在术前进行了放化疗（CRT），仍有8%至12%的侧盆腔复发率。侧方淋巴结的大小以及对术前CRT的反应性应是选择合适患者进行侧方淋巴结清扫术的主要因素。此外，从最近的文献来看，腹腔镜侧方淋巴结清扫术是安全的，在肿瘤学上是可行的，并且可能在短期预后方面具有一些优势。
