Download PDF
Clin Colon Rectal Surg 2020; 33(06): 349-354
DOI: 10.1055/s-0040-1714238
Review Article

Japanese Evidences on Nerve-Preserving Lateral Pelvic Lymh Node Dissection for Rectal Cancer

Major Historical Milestones and Clinical Impact: The Past, Present and Future
Yukihide Kanemitsu
1   Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
,
Dai Shida
1   Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
,
Shunsuke Tsukamoto
1   Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
,
Konosuke Moritani
1   Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
,
Ryohei Sakamoto
1   Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

In Japan, the standard treatment for advanced low rectal cancer has been total mesorectal excision (TME) + lateral pelvic lymph node dissection (LLND). On the other hand, in the West, preoperative chemoradiotherapy (CRT) + TME has been established as the standard. Japanese surgeons developed nerve-preserving LLND that could reduce complications associated with extended dissection. The Japan Clinical Oncology Group (JCOG)0212 trialinvestigated on the outcomes of so-called prophylactic LLND in patients without evident lateral lymph node metastasis in preoperative diagnostic imaging. Data from the JCOG0212 trial demonstrated scientific validity of the theory and practice of the Japanese approach. Data from the JCOG0212 trial supported the validity and safety of the Japanese approach, that is, TME + LLND for low rectal cancer without routine use of preoperative CRT. For future direction, modern approach for rectal cancer should involve both of the Eastern and Western strategies by combining LLND and CRT.

Keywords

rectal cancer - lateral lymph node dissection - total mesorectal excision


Publication History

Article published online:
14 September 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Fujita S, Mizusawa J, Kanemitsu Y. , et al; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 2017; 266 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 2 Fujita S, Akasu T, Mizusawa J. , et al; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 2012; 13 (06) 616-621
    CrossrefPubMedGoogle Scholar
  • 3 Gerota D. Die Lymphgefaesse des Rectums und Anus. Arch Anat Physiol, Anat Abt 1895: 240-256
  • 4 Poirier P, Cunéo B, Delamere G. The Lymphatics. Chicago: WT Keener; 1904
    Google Scholar
  • 5 Miles WE. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 1908; 2: 1812-1813
    CrossrefPubMedGoogle Scholar
  • 6 Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?. Br J Surg 1982; 69 (10) 613-616
    CrossrefPubMedGoogle Scholar
  • 7 Senba T. Anatomical study on lymphatic system in rectum. Fukuoka Medical J 1927; 20: 1213-1268
    PubMedGoogle Scholar
  • 8 Villemin F, Haurd P, Montagne M. Recherches anatomiques sur les lymphatiques du rectum et de l'anus. Rev Chir 1925; 63: 39-80
    PubMedGoogle Scholar
  • 9 Kuru M. Rectal cancer. Jpn J Surg 1941; 41: 832-877
    PubMedGoogle Scholar
  • 10 Takahashi T, Kajitani T. Lateral spread of cancer and meaning of lateral pelvic nodes dissection in rectal cancer surgery. J Jpn Soc Colo-proctol 1978; 31: 207-219
    CrossrefPubMedGoogle Scholar
  • 11 Bacon HE. Cancer of the Colon, Rectum and Anal Canal. Philadelphia: JB Lippincott; 1964
    Google Scholar
  • 12 Stearns Jr MW, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 1959; 2 (02) 169-172
    CrossrefPubMedGoogle Scholar
  • 13 Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. 2nd English ed. Tokyo: Kanehara & Co., Ltd.; 2009
    Google Scholar
  • 14 Koyama Y. Extended dissection for rectal cancer. Geka Chiryo 1977; 6: 41-45
    PubMedGoogle Scholar
  • 15 Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 1989; 32 (02) 128-133
    CrossrefPubMedGoogle Scholar
  • 16 Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 1989; 32 (04) 307-315
    CrossrefPubMedGoogle Scholar
  • 17 Tsuchiya S. Autonomic nerve preservation in rectal cancer surgery. Surgery 1982; 44: 1367-1373
    PubMedGoogle Scholar
  • 18 Watanabe T, Itabashi M, Shimada Y. , et al; Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 2015; 20 (02) 207-239
    CrossrefPubMedGoogle Scholar
  • 19 Kanemitsu Y, Komori K, Shida D. et al. Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND. Surgery 2017; 162 (02) 303-314
    CrossrefPubMedGoogle Scholar
  • 20 Sugihara K, Kobayashi H, Kato T. et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 2006; 49 (11) 1663-1672
    CrossrefPubMedGoogle Scholar
  • 21 Nagawa H, Muto T, Sunouchi K. et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 2001; 44 (09) 1274-1280
    CrossrefPubMedGoogle Scholar
  • 22 Wanebo HJ, Antoniuk P, Koness RJ. et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 1999; 42 (11) 1438-1448
    CrossrefPubMedGoogle Scholar
  • 23 Fong Y, Cohen AM, Fortner JG. et al. Liver resection for colorectal metastases. J Clin Oncol 1997; 15 (03) 938-946
    CrossrefPubMedGoogle Scholar
  • 24 Okumura S, Kondo H, Tsuboi M. et al. Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients. J Thorac Cardiovasc Surg 1996; 112 (04) 867-874
    CrossrefPubMedGoogle Scholar
  • 25 Shirai M. Examination of the validity in Japan of the International Index for Erectile Function. IMPOTENCE 1999; 14: 1-28
    PubMedGoogle Scholar
  • 26 Saito S, Fujita S, Mizusawa J. , et al; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 2016; 42 (12) 1851-1858
    CrossrefPubMedGoogle Scholar
  • 27 Ito M, Kobayashi A, Fujita S. , et al; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 2018; 44 (04) 463-468
    CrossrefPubMedGoogle Scholar
  • 28 Ogura A, Konishi T, Cunningham C. , et al; Lateral Node Study Consortium. Neoadjuvant (Chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol 2019; 37 (01) 33-43
    CrossrefPubMedGoogle Scholar