Ogawa S, Itabashi M, Inoue Y, Ohki T, Bamba Y, Koshino K, Nakagawa R, Tani K, Aihara H, Kondo H, Yamaguchi S, Yamamoto M. Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management. World J Gastrointest Oncol 2021; 13(10): 1412-1424 [PMID: 34721774 DOI: 10.4251/wjgo.v13.i10.1412]
Corresponding Author of This Article
Shimpei Ogawa, MD, PhD, Associate Professor, Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. ogawa.shimpei@twmu.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shimpei Ogawa, Michio Itabashi, Yuji Inoue, Takeshi Ohki, Yoshiko Bamba, Kurodo Koshino, Ryosuke Nakagawa, Kimitaka Tani, Hisako Aihara, Hiroka Kondo, Shigeki Yamaguchi, Masakazu Yamamoto, Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
Author contributions: Ogawa S, Itabashi M, Inoue Y, Ohki T, Bamba Y, Koshino K, Nakagawa R, Tani K, Aihara H, Kondo H, Yamaguchi S and Yamamoto M conceptualized and designed the study; Ogawa S performed the data analysis and interpretation; Ogawa S and Itabashi M revised the manuscript for important intellectual content; Ogawa S, Itabashi M and Yamamoto M provided the final approval for the manuscript to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shimpei Ogawa, MD, PhD, Associate Professor, Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. ogawa.shimpei@twmu.ac.jp
Received: February 21, 2021 Peer-review started: February 21, 2021 First decision: May 8, 2021 Revised: May 21, 2021 Accepted: August 24, 2021 Article in press: August 24, 2021 Published online: October 15, 2021 Processing time: 233 Days and 23 Hours
Abstract
The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer are described in this review. Magnetic resonance imaging (MRI) is recommended for the diagnosis of LPLN metastasis. A LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications; therefore, LPLD may not be appropriate for cases that are less likely to have LPLN metastasis. Radiation therapy (RT) and chemoradiation therapy (CRT) have limited effects in cases with suspected LPLN metastasis, but a combination of preoperative CRT and LPLD may improve the treatment outcome. Thus, RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.
Core Tip: Diagnosis of lateral pelvic lymph node (LPLN) metastasis of rectal cancer is mainly made using magnetic resonance imaging (MRI). LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) reduces recurrence in the lateral pelvis but also has complications and may not be appropriate for cases predicted to not have LPLN metastasis. Preoperative radiation therapy (RT) or chemoradiation therapy (CRT) can improve the treatment outcome. Thus, RT and CRT plus selective LPLD may produce favorable treatment outcomes.
