Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12404
Peer-review started: August 31, 2022
First decision: September 26, 2022
Revised: September 30, 2022
Accepted: October 24, 2022
Article in press: October 24, 2022
Published online: November 26, 2022
Processing time: 82 Days and 5 Hours
There are a few cases of lateral lymph node (LLN) metastasis (LLNM) of T1 rectal cancer. Moreover, LLNM is easily missed, especially in patients with early-stage rectal cancer. To our knowledge, the possibility of bilateral LLNM before surgery has not been reported in previous studies.
A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp. The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma. She was considered to have bilateral LLNM after the examination at our hospital. Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM. The patient received long-course adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.
T1 rectal cancer could lead to LLNM and possibly, bilateral LLNM. Therefore, adequate clinical evaluation is essential for these patients.
Core Tip: T1 rectal cancer is rarely accompanied by lymph node metastases, and even fewer lateral lymph node (LLN) metastases (LLNM). To our knowledge, the published case reports to date have mainly reported cases of heterochronous LLNM, only two cases with simultaneous metastases, and only one case of missed LLNM after endoscopic submucosal dissection (ESD). For patients with no residual tumor after ESD, in whom LLNM is suspected, it is also inconclusive whether only LLN dissection could be performed.