Is it appropriate inspection assuming that positive CRM and bowel perforation is major cause of local selleckbio recurrence after abdominoperineal resection? Some reports say that lateral node metastasis is major cause of local recurrence. We must share following views that the east and the west should join forces to improve selection criteria for lateral node dissection and neoadjuvant treatment to prevent overtreatment, and ultimately aim to improve quality of life and oncological outcome for patients with low rectal cancer. Keywords: Low rectal cancer, Lateral pelvic lymph nodes metastases, Lateral pelvic lymph nodes dissection, Preoperative chemoradiotherapy The role of surgery is central for the treatment of rectal cancer. The search for decades has been continuing to minimize local recurrence after surgical resection.
One feature of rectal cancer that remains controversial is the significance of lateral pelvic lymph nodes (LPN), because total mesorectal excision (TME) does not remove these nodes. Gerota, in 1895, described the lateral and the upward lymphatic flow of the rectum as shown by a dye injection method (1). Poirier and colleagues described three lymphatic vessels for lateral lymphatics. The significance of the peritoneal reflection as a landmark in low and high lesion was described by Villemin et al. in 1925 (2). In Japan, in 1927, Senba conducted an anatomic study on lymphatics of the rectum by injecting a dye into fetus cadavers and concluded that the lateral lymphatic vessels are distributed around the internal iliac arteries and inside the obturator spaces (3).
Today it is generally understood that some lymphatics, mostly from the lower rectum, easily penetrate into extra-mesenteric lymphatics through the lateral ligament and ascend along the internal iliac arteries. These lymphatics are called LPNs. Based on these historical researches, since 1970��s, a clearance of LPNs on both sides has become a routine procedure for low-lying rectal cancer in leading hospitals in Japan. In Japanese guideline, the tumor is described according to anatomical relationships, defining the low rectal cancer as tumor located below the peritoneal reflection (4). Due to anatomic variation and differences in sex, the distance of the peritoneal reflection to the anal verge can differ from 6 to 9cm.
Thus, cohorts of patients with low rectal cancer in Japan probably also contain tumors which would be defined as ��middle�� in Western terms. Although the terminology for clearance of LPNs has varied considerably, LPN dissection (LPND) is thought to be appropriate Brefeldin_A to encompass surgical excision of LPNs. Here, we would like to look back on the brief history of LPND. In 1951, Sauer and Bacon published their initial results with LPND for rectal cancer in 32 patients (5). In 1959, Stearns and Deddish reported results on 122 patients who performed LPND.