|Invited Lecture (JSGS)|
|Sat. October 14th 9:00 - 9:40 Room 6: Fukuoka International Congress Center 203+204|
|Lateral pelvic lymph node dissection and multimodality treatment for rectal cancer: Mutually exclusive or mutually beneficial?|
|G. J. Chang|
|The University of Texas, MD Anderson Cancer Center|
| The optimal approach to treatment for patients with low rectal cancer is the subject of debate and a matter of East-West philosophical divide. Landmark randomized trials have demonstrated the superiority of combination modality therapy with neoadjuvant chemoradiation (nCRT) followed by total mesorectal excision (TME) to TME alone for locoregional disease control. In contrast, the alternative primary surgical approach that includes TME with prophylactic dissection of internal iliac and obturator lymph nodes has been promoted as an effective strategy for patients with distal rectal cancers and is associated with good local control.
Traditionally surgeons across the lateral pelvic nodal divide have argued for the superiority and relative merits of one strategy over the other. To date that has been no direct head to head comparison of total mesorectal excision with lateral pelvic lymph node dissection to neoadjuvant chemoradiation therapy to total mesorectal excision. Unfortunately, each approach is associated with both potential toxicities and therapeutic advantages. The recent publication of oncologic outcomes following total mesorectal excision alone versus total mesorectal excision with lateral pelvic lymph node dissection has provided new information to help inform clinical decision making. However, despite either a neoadjuvant chemoradiotherapy approach or primary surgery with lateral pelvic lymph node dissection, locoregional disease failure still remains an important clinical concern.
For rectal cancer, progress in treatment may not come from continuing to pit the strategies of the East against those of the West but rather from a global tailored approach that appropriately combines the strategies of neoadjuvant treatment and lateral node dissection. It highlights the need for ongoing international collaboration, standardization, and cross pollination of ideas to make true progress for patients with resectable rectal cancer.