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Updated: May 5, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Role of Lateral Pelvic Lymph Node Dissection Following Neoadjuvant Chemoradiation Therapy in Rectal Cancer: A
Eunyeong Yang1, Gyu Sang Yoo2, Hee Chul Park1
1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Lateral pelvic lymph node dissection (LPLND) after neoadjuvant chemoradiation therapy (nCRT) did not improve outcomes for rectal cancer patients overall. However, LPLND may benefit select patients with larger lateral pelvic lymph nodes post-treatment.
Area of Science:
- Oncology
- Surgical Oncology
- Rectal Cancer Management
Background:
- Lateral pelvic lymph node (LPLN) metastasis is a significant negative prognostic indicator in rectal cancer.
- Optimal surgical management for LPLN involvement post-neoadjuvant chemoradiation therapy (nCRT) remains debated.
- Identifying patients who benefit from LPLN dissection (LPLND) is crucial for improving treatment strategies.
Purpose of the Study:
- To investigate the efficacy of LPLND combined with total mesorectal excision (TME) in patients with locally advanced rectal cancer and LPLN involvement.
- To evaluate the impact of LPLND on lateral pelvic recurrence-free rate (LRFR) and recurrence-free survival (RFS) after nCRT.
- To identify patient subgroups who may benefit from LPLND.
Main Methods:
- Multicenter retrospective study including 559 patients with locally advanced rectal cancer and LPLN involvement (KROG 22-09).
- Patients underwent either LPLND (n=189) or no LPLND (n=370) with TME post-nCRT.
- Propensity score matching (PSM) was employed to control for confounding factors; LRFR and RFS were assessed.
Main Results:
- Overall, LPLND did not significantly improve 5-year LRFR or RFS compared to no LPLND, both before and after PSM.
- Patients undergoing LPLND had initially more advanced disease and larger LPLNs.
- LPLND significantly improved LRFR in patients with post-nCRT LPLN longest short axis (LSA) ≥ 5 mm (98.0% vs. 80.9%, p=0.033).
Conclusions:
- LPLND following nCRT does not significantly reduce pelvic recurrence or enhance survival in the general rectal cancer population with LPLN involvement.
- Patient selection is critical; LPLND may offer a survival benefit for a specific subgroup with larger LPLNs after nCRT.
- Further prospective studies are warranted to confirm the role of LPLND in selected rectal cancer patients.
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