ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Current therapeutic strategies in approaching pelvic lateral adenopathy in rectal cancer


Introduction: Rectal cancer is still an important morbidity and mortality cause in industrialized countries. The multi-disciplinary management requires continuous improvement in terms of investigative procedures and therapeutic strategies.
The surgical treatment, either anterior resection or abdominal-perineal resection with total mesorectum excision (TME) represents the” gold standard” of the therapeutic algorithm as it is the main method intended to achieve oncological radicalness.
Both surgical resection with TME and the neo-adjuvant and adjuvant treatment strategies crucially contribute to the decrease of local relapses and possibly to the control of systemic disseminations thus improving survival. The pelvic lateral adenopathy detected in a significant number of patients determines local relapse and the survival of the patient with rectal neoplasm. Within the surgical treatment of rectal cancer, the dissection of the lymph nodes of the lateral pelvic compartment with or without neo-adjuvant chemoradiotherapy is currently a controversial subject.

Materials and methods: In carrying out this paperwork, publications from 2010-2015 were analyzed; these publications contain significant data, well supported by specialty studies regarding the therapeutic attitude towards pelvic lateral lymphadenopathy in rectal cancer.
At the same time, it was also analyzed the conformity of references related to the proposed therapeutic strategies that lead to the improvement of oncological results as well as the reproducibility of the used methods.

Results: The studies provide exact data regarding the importance of pelvic lateral adenopathy in the evolution and prognosis of the patient suffering from rectal neoplasm. It is also highlighted the favorable effect of LPLD – lateral pelvic lymph node dissection in improving the survival rate even under the conditions of a significant associated morbidity. Assessment by MRI (magnetic resonance imaging) of the lateral pelvic compartment is necessary in order to detect adenopathies at risk correlated with disseminat- ed disease but also for setting up the therapeutic algorithm. The imagistic assessment of pelvic lateral lymph nodes is poor following neo-adjuvant chemoradiotherapy (CRT); in these conditions, some authors recommend LPLD with a prophylactic approach.

Conclusions: After reviewing the specialized literature and the evaluation of the applicability of proposed treatments, a lack of general agreement is found, regarding the therapeutic attitude towards pelvic lateral adenopathy in rectal cancer. In Europe and the USA, the lateral pelvic neoplastic determination from the rectal neoplasm is classified as system dissemination although the associated prognosis and incidence are similar with those reported in Japan where it is considered as a regional lymph node metastasis. The post-therapeutic morbidity associated with LPLD calls for a better selection of patients as well as for the improvement of the nerve preservation techniques. In order to lay down standardized recommendations, additional studies are necessary in order to carry out a highly accurate pre-operative assessment of the disease stage and to estimate both comparatively and in an associated form the therapeutic strategies: CRT and or LLPD.

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