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Related Experiment Video

Updated: Jan 12, 2026

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Surgical Procedure of Lateral Lymph Node Dissection for Advanced Lower Rectal Cancer.

Mamoru Uemura1, Jun Watanabe2,3, Akio Shiomi4

  • 1Department of Gastroenterological Surgery Graduate School of Medicine, The University of Osaka Osaka Japan.

Annals of Gastroenterological Surgery
|November 7, 2025
PubMed
Summary

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Standardizing lateral lymph node dissection (LLND) for rectal cancer improves quality. Key anatomical landmarks and dissection boundaries were confirmed to enhance surgical consistency and efficacy.

Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Rectal Cancer Treatment

Background:

  • Lateral lymph node dissection (LLND) is crucial for locally advanced lower rectal cancer to reduce recurrence.
  • Lack of standardized techniques and anatomical landmarks hinders efficacy assessment.

Purpose of the Study:

  • To establish standardized techniques and anatomical landmarks for LLND.
  • To improve the quality and consistency of LLND procedures.

Main Methods:

  • Consensus meeting held by the Japan Society of Gastroenterological Surgery (JSGS).
  • Identification and confirmation of essential anatomical landmarks for LLND.
  • Definition of dissection boundaries and target lymph node stations (283 and 263).
Keywords:
lateral lymph node dissectionlower rectal cancersurgical procedure

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Main Results:

  • Confirmed essential anatomical landmarks for LLND.
  • Defined primary dissection regions: obturator (station 283) and internal iliac (station 263).
  • Established medial boundaries (uretero-hypogastric fascia) and central plane (vesico-hypogastric fascia).
  • Identified indicators of successful dissection: sciatic nerve, inferior vesical vessels, internal pudendal artery, and coccygeus muscle exposure.

Conclusions:

  • The consensus provides a standardized framework for LLND.
  • This standardization is expected to enhance LLND quality and treatment efficacy assessment.
  • Aims to reduce local recurrence in patients with locally advanced lower rectal cancer.