Is prophylactic lateral lymph node dissection needed for lower rectal cancer? A single-center retrospective study

Area of Science:

• Oncology
• Surgical Oncology
• Rectal Cancer Research

Background:

• The role of prophylactic lateral lymph node dissection (LLND) in lower rectal cancer is debated.
• Establishing the survival impact of LLND is crucial for treatment decisions.

Purpose of the Study:

• To retrospectively analyze the survival outcomes of prophylactic LLND in patients with lower rectal cancer.
• To evaluate the necessity of LLND in T3 lower rectal cancer without preoperative lymph node metastasis.

Main Methods:

• Retrospective analysis of 301 patients with lower rectal cancer (T3, no preoperative lateral lymph node metastasis).
• Exclusion of patients receiving neoadjuvant therapy.
• Comparison of relapse-free survival (RFS) and overall survival (OS) between LLND (n=37) and non-LLND (n=264) groups.

Main Results:

• No significant differences in 5-year RFS (66.8% vs 72.5%), OS (79.7% vs 86.5%), or cancer-specific survival (86.0% vs 88.9%) between groups.
• Similar rates of lateral lymph node recurrence (2.7% vs 3.8%) were observed.
• The dissection group had fewer men and younger patients.

Conclusions:

• Prophylactic LLND demonstrated limited effectiveness in T3 lower rectal cancer patients without preoperative lymph node metastasis.
• LLND may not be essential when preoperative lymph node metastasis is absent, irrespective of tumor invasion depth.