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Updated: Jul 11, 2026
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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Where does the first lateral pelvic lymph node receive drainage from?
Hidejiro Kawahara1, Hiroshi Nimura, Kazuhiro Watanabe
1Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. kawahide@jikei.ac.jp
Digestive Surgery
|September 15, 2007
Summary
Identifying lateral pelvic lymph node metastases in rectal cancer is crucial. Indocyanine green (ICG) combined with infrared ray electronic endoscopy (IREE) accurately detected drainage to internal iliac artery nodes in 43% of patients.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Lateral pelvic lymph node dissection (LPLD) for rectal cancer presents risks and benefits.
- Accurate preoperative detection of lateral lymph node metastases is needed to avoid unnecessary LPLD.
- Identifying the primary drainage pathway can guide LPLD decisions.
Purpose of the Study:
- To evaluate the utility of indocyanine green (ICG) fluorescence imaging for detecting lymphatic drainage in lower rectal cancer.
- To determine the specific location of initial lateral pelvic lymph node involvement.
Main Methods:
- 14 patients with T3 lower rectal cancer underwent preoperative ICG injection.
- Total mesorectal excision was performed, followed by LPLD using infrared ray electronic endoscopy (IREE).
- ICG retention in regional lymph nodes was assessed to map lymphatic drainage patterns.
Main Results:
- ICG drainage to lateral pelvic lymph nodes was observed in 6 of 14 patients (43%).
- All ICG-positive lymph nodes were successfully identified using IREE.
- When detected, lymphatic drainage was confined to the peri-internal iliac artery nodes, with no obturator node involvement.
Conclusions:
- The primary lymphatic drainage pathway from lower rectal cancer involves lymph nodes around the internal iliac arteries.
- ICG fluorescence imaging is a viable method for identifying key lateral pelvic lymph nodes in rectal cancer.
- This technique may help personalize the decision-making process for LPLD.
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