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Updated: Aug 23, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Long-term outcomes after salvage surgery for isolated lateral lymph node recurrence in rectal cancer
Treerat Tangpulphon1,2,3, Akira Ouchi4, Nattapanee Sukphol5
1Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Purpose:
To evaluate the oncologic outcomes and prognostic factors after salvage lateral lymph node resection for isolated lateral lymph node recurrence (LLNR).
Methods:
Rectal cancer patients with isolated LLNR who underwent salvage surgery at tertiary centers in Japan and Thailand between January 2013 and December 2024 were included. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and local re-recurrence.
Results:
Thirty patients were included, with a median follow-up of 47.5 months. Salvage procedures included tumor resection in 19 patients (63.3%), tumor resection with adjacent organ resection in 5 (16.7%), and total pelvic exenteration in 6 (20.0%). After salvage surgery, 21 patients (70.0%) developed re-recurrence, and 11 (36.7%) had local re-recurrence. The five-year OS was 73.8%, 5-year RFS was 22.3%, and 5-year cumulative incidence of local re-recurrence was 61.7%. A multivariate analysis revealed that extensive salvage operations, including tumor resection with adjacent organ resection and total pelvic exenteration, were strongly associated with local re-recurrence (HR 8.43, p = 0.014). An LLN size ≥ 17 mm tended to increase the risk of local re-recurrence (HR 3.52, p = 0.071).
Conclusion:
Salvage resection for isolated LLNR provides an acceptable OS, but re-recurrence remains frequent. Careful patient selection using PET-CT and multidisciplinary discussions are essential, particularly for patients who require extensive surgery.
