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Invited Commentary
July 3, 2019

Lateral Lymph Nodes as the Achilles Heel of Low Rectal Cancer Surgery After Neoadjuvant Chemoradiation Therapy: Are We Close to Solving the Riddle?

Author Affiliations
  • 1Department of Surgery, St Thomas’ Hospital, London, United Kingdom
  • 2Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Surg. Published online July 3, 2019. doi:10.1001/jamasurg.2019.2220

The management of locally advanced rectal cancer has been a topic of debate between surgical schools in the East and the West, and to date, there is still no formal consensus or mutually agreed-on guidelines. While in Western countries, neoadjuvant chemoradiation therapy followed by total mesorectal excision has been the standard of care for 2 decades now, 2 recent studies1,2 have demonstrated that this approach does not prevent lateral lymph node recurrence.3 On the contrary, prophylactic lateral lymph node dissection has been the standard of care for locally advanced rectal cancer in Eastern countries, with predominance in Japan.4 Pelvic magnetic resonance imaging (MRI) has become an invaluable instrument to establish local disease extension and lymph node involvement in locally advanced rectal cancer, with important prognostic value when it is repeated after the completion of neoadjuvant chemoradiation therapy to assess tumor response.5

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