Annals of Coloproctology

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Original Article

Colorectal cancer

Predictors of lateral lymph node metastasis and prognostic factors in patients with low rectal cancer who underwent lateral lymph node dissection without preoperative treatment: Riki Ohno, Haruka Oi, Soichiro Natsume, Kazuki Kawasaki, Yuichiro Yoshioka, Nao Kakizawa, Junko Kishikawa, Toshiya Nagasaki; Ann Coloproctol. 2025;41(6):545-553. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2025.00675.0096

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Purpose
This study aimed to identify predictors of lateral lymph node metastasis (LLNM) and assess prognostic factors in patients with locally advanced low rectal cancer (LALRC), with the goal of informing optimal treatment strategies for LALRC.
Methods
We retrospectively analyzed clinicopathological data from patients with LALRC who underwent lateral lymph node dissection without preoperative treatment between 2014 and 2023. The radiological criterion for LLNM was a short-axis diameter of ≥6 mm on magnetic resonance imaging (MRI).
Results
Of 163 patients, 27 (16.6%) had pathological LLNM (pLLNM). Among 130 patients preoperatively classified as LLNM-negative, 5 (3.8%) were found to have pLLNM. Univariate and multivariate analyses showed that meeting the radiological LLNM criterion independently predicted pLLNM (odds ratio, 53.000; P<0.001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this criterion were 90.2%, 81.5%, 91.9%, 66.7%, and 96.2%, respectively. In multivariate analyses, pLLNM was an independent risk factor for 3‑year relapse‑free survival. MRI‑detected extramural vascular invasion (mrEMVI) was independently associated with 3‑year relapse‑free survival, local recurrence‑free survival, and distant recurrence‑free survival.
Conclusion
These radiological criteria may help clinicians develop personalized treatment plans for patients with LALRC. The high negative predictive value and specificity of LLNM assessment can assist in avoiding overtreatment in appropriate patients. Further evaluation is needed to define optimal management for mrEMVI‑positive cases.

Citations

Citations to this article as recorded by

Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

Review

Colorectal cancer

Essential anatomy for lateral lymph node dissection: Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara; Ann Coloproctol. 2023;39(6):457-466. Published online December 8, 2023; DOI: https://doi.org/10.3393/ac.2023.00164.0023

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9 Citations

Abstract PDF

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by

Colorectal Surgery
John H. Marks, Brandon K. Vu, Sarah Liu, Deborah Nagle
Surgical Clinics of North America.2026; 106(5): 733. CrossRef
Impact of lateral lymph node dissection on urogenital function and surgical outcomes following neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer: a systematic review and meta-analysis
Hao-Zhu Liu, Xiao Bai, Xin-Mao Zhu, Dong-Qiu Dai
Surgical Endoscopy.2026;[Epub] CrossRef
Clinical case of simultaneous robot-assisted low anterior resection with radical prostatectomy and bilateral pelvic lymph node dissection
I. S. Ignatov, A. A. Derinov, V. V. Balaban, E. A. Bezrukov, N. N. Muradova, P. A. Volkova, A. K. Yaylakhanyan, P. V. Tsarkov
Surgery and Oncology.2026; 16(2): 144. CrossRef
da Vinci robotic-assisted micro-space dissection and autonomic nerve network preservation technique in the total mesorectal excision procedure for rectal cancer: a single-center, retrospective, observational, real-world study
Fanghai Han, Yequan Xie, Guangyu Zhong, Jintao Zeng, Yang Chen, Jianan Tan, Shengning Zhou
Journal of Robotic Surgery.2025;[Epub] CrossRef
Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
Techniques in Coloproctology.2025;[Epub] CrossRef
Deep learning-based vessel and nerve recognition model for lateral lymph node dissection: a retrospective feasibility study
Shoma Sasaki, Daichi Kitaguchi, Tomohiro Noda, Hiroki Matsuzaki, Hiro Hasegawa, Nobuyoshi Takeshita, Masaaki Ito
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef
The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
Gyu-Seog Choi, Hye Jin Kim
Annals of Coloproctology.2024; 40(4): 363. CrossRef
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Annals of Coloproctology.2024; 40(4): 375. CrossRef

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