REVIEW  RECTAL CANCER TREATMENT IN THE 21ST CENTURY 

Minerva Chirurgica 2018 December;73(6):558-73

DOI: 10.23736/S0026-4733.18.07704-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Laparoscopic treatment of rectal cancer and lateral pelvic lymph node dissection: are they obsolete?

Shigeo TODA✉, Hiroya KUROYANAGI, Shuichiro MATOBA, Kosuke HIRAMATSU, Naoto OKAZAKI, Tomohiro TATE, Kenji TOMIZAWA, Yutaka HANAOKA, Jin MORIYAMA

Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

Laparoscopic surgery for rectal cancer offers favorable short-term results without compromising long term oncological outcomes so far, according to the data from major trials. For this reason, it is currently considered as a standard option for rectal cancer surgery. The learning curve of laparoscopic rectal cancer surgery is generally longer compared to colon cancer. Appropriate standardization and training of laparoscopic rectal cancer surgery is required. Several RCTs suggested the potential negative effect on quality of resected specimen, which can increase local recurrence. The long-term outcomes - especially local recurrence rate - of these RCTs are awaited. Lateral pelvic lymph node dissection (LPLND) has a certain effect of reducing local recurrence of rectal cancer even after neoadjuvant radiotherapy. Since LPLND is associated with postoperative morbidity, we should carefully select the candidate to maximize the effect of LPLND and minimize the morbidity caused by LPLND. Recent advancements in imaging study such as CT and MRI enable us to find the suitable candidates for LPLND. The morbidity caused by LPLND could be reduced by minimally invasive surgeries such as laparoscopic surgery and robotic surgery. We have to improve oncological outcomes and reduce morbidity by the multidisciplinary strategy for rectal cancer including total mesorectal excision, neoadjuvant chemoradiotherapy and LPLND together with laparoscopic surgery.

KEY WORDS: Laparoscopy - Rectal neoplasms - Lymph node excision - Local neoplasm recurrence