Lateral Pelvic Lymph Node Dissection for low locally advanced rectal cancer: a review

Lateral pelvic lymph node dissection for advanced low rectal cancer has generated much discussion in the literature in last few years. Whilst it is still being debated as to whether it constitutes a locoregional disease amenable to surgery, or whether it is a distant metastases requiring neoadjuvant therapy, what is clear is that patients with enlarged lateral pelvic lymph nodes have higher rate of recurrence. In this review, we have analysed the current evidence and recommendations for lateral pelvic lymph node dissection. If advanced low rectal cancer (stage II, stage III) below peritoneal reflection, the decision to perform LPLND depends on (1) size of LPLN on MRI (>5mm) prior to neoadjuvant chemoradiotherapy and (2) non-responsive LPLN after CRT (LPLN >5mm before and after CRT). LPLN does prolong the operating time, and greater blood loss, however, is not associated with any greater morbidity. Preservation of the neurovascular structures, including the obturator nerves, hypogastric nerves, and the inferior vesical arteries must be identified and preserved. We have also described the key steps in performing lateral pelvic lymph node dissection.