The Role of Lateral Pelvic Node Dissection in Rectal Cancer Surgery View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2019-03-06

AUTHORS

Fumio Konishi , Tsuyoshi Konishi

ABSTRACT

Over time there have been significant differences in the surgical management of rectal cancers between Japan and Western countries. In the Western world, preoperative chemoradiation and total mesorectal excision (TME) have become the standards in an attempt to reduce the locoregional recurrence rate and to improve long-term cancer-specific outcomes. A similar view concerning cancer aims has occurred in Japan where mesorectal excision is often routinely performed in concert with lateral pelvic lymph node dissection (LPND) for low rectal cancers. In 1993 Heald et al. [1] described the technique of TME and highlighted the importance of complete excision of the mesorectum for tumours of the mid- and lower rectum. A similar approach had been adopted by Japanese colorectal surgeons even before TME was introduced by Heald. A difference in mesorectal dissection between the two environments, however, is the “Tumor Specific Mesorectal Excision (TSME)” which is commonly performed in Japan [2] where the mesorectum is not completely excised down to the pelvic floor in selected cases [3]. The decision whether to perform a TME or a TSME is dependent upon the level of the tumour although the fundamental concept of appropriate mesorectal dissection (in the mesorectal plane) is similar between Japan and other Western countries. This view is allied to the known benefits of selective preoperative chemo-radiation prior to TME where literature consistently shows lower locoregional recurrence rates when preoperative chemo-radiation was added to TME. Despite this, however, the long-term benefits of preoperative chemo-radiation remain to be fully established [4]. More... »

PAGES

307-322

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-98902-0_17

DOI

http://dx.doi.org/10.1007/978-3-319-98902-0_17

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112540325


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