| International Session（Symposium）6(JSGS・JSGE・JGES) |
| Fri. November 22nd 9:30 - 12:00 Room 12: Kobe International Conference Center Main Hall |
| Total mesolectal excision with or without lateral lymph node dissection for low rectal cancer | |||
| Yukihide Kanemitsu | |||
| National Cancer Center | |||
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| In the West, multimodality treatment with chemoradiation was developed with the intent of controlling microscopic disease for low rectal cancer, at a time when failures in operative treatment within the central compartment were common. Involved sidewall nodes are considered indicative of the presence, or imminent predictors, of systemic disease. In Japan, on the other hand, lateral nodal involvement is considered common and amenable to surgical resection. The JCOG Colorectal Cancer Study group has treated lower rectal cancer as “low- to middle-risk" in the absence of lateral lymph node metastasis and "high risk" in the case of such metastasis. The JCOG0212 study aimed to determine whether total mesolectal excision (TME) alone was non-inferior to TME with lateral lymph node dissection (LLND), in terms of efficacy, for low-to middle-risk patients with no evidence of extra-mesorectal lymph node metastases on CT or MRI. A total of 701 patients were randomized to the TME alone group or the TME+LLND group, between 2003 and 2010. In the primary analysis, not only the non-inferiority of TME alone to nerve-preserving LLND was not demonstrated in RFS as the primary endpoint, but also the inferiority of TME alone to TME＋LLND was demonstrated in the local recurrence rate as the secondary endpoint. The main message for the West from this trial is that not “treating” the lateral compartment will result in high local recurrence rates (17.6% 5-year rate). |
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Index Term 1: Rectal cancer Index Term 2: Lateral lymph node dissection |
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