Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management

Abstract

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer are described in this review. Magnetic resonance imaging (MRI) is recommended for the diagnosis of LPLN metastasis. A LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications; therefore, LPLD may not be appropriate for cases that are less likely to have LPLN metastasis. Radiation therapy (RT) and chemoradiation therapy (CRT) have limited effects in cases with suspected LPLN metastasis, but a combination of preoperative CRT and LPLD may improve the treatment outcome. Thus, RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Keywords: Diagnosis; Treatment; Rectal cancer; Lateral pelvic lymph node metastasis; Lateral pelvic lymph node dissection; Radiotherapy

Core Tip: Diagnosis of lateral pelvic lymph node (LPLN) metastasis of rectal cancer is mainly made using magnetic resonance imaging (MRI). LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) reduces recurrence in the lateral pelvis but also has complications and may not be appropriate for cases predicted to not have LPLN metastasis. Preoperative radiation therapy (RT) or chemoradiation therapy (CRT) can improve the treatment outcome. Thus, RT and CRT plus selective LPLD may produce favorable treatment outcomes.