Current surgical management of rectal cancer

The management of rectal cancer has undergone significant evolution over the past decade with improvements in both surgical technique and adjuvant therapies. The progression of surgical management has been of particular interest, as surgery is the only potentially curative treatment. The major goals of surgery are to optimize oncologic outcome and maintain anorectal and genitourinary function. There are presently two approaches to rectal cancer surgery: total mesorectal excision (TME), which is the gold standard in the Western world, and lateral lymph node dissection, which was originally developed in Japan. Although the results of lateral lymph node dissection are similar to TME with prior radiotherapy, low positive lateral lymph node yields, questionable prognostic significance, and high morbidity are the main drawbacks of this procedure. Despite the current quality of these surgical procedures, locoregional treatment is limited as advanced primary rectal cancer may be associated with systemic spread of disease. Adjuvant therapy therefore plays a key role in obtaining further improvement in survival. In this article, evidence for the use and benefits of lateral lymph node dissection surgery for rectal cancer patients in Japan is reviewed, and its application in association with TME and other modalities considered.