PDF(Pubmed)
Abstract：
In this editorial, we proceed to comment on the article by Chua et al, addressing the management of metastatic lateral pelvic lymph nodes (mLLN) in stage II/III rectal cancer patients below the peritoneal reflection. The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians, albeit with a higher degree of convergence in recent years. The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries. In contrast, in the West, preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy, that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision. In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy, the risk of lateral local recurrence increases, suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile. Despite the heterogeneous and retrospective nature of studies addressing this area, an international consensus is necessary to approach this clinical scenario uniformly.
摘要：
在这篇社论中，我们继续评论蔡等人的文章，解决腹膜反射以下II/III期直肠癌患者转移性盆腔外侧淋巴结（mLLN）的管理。由于东西方医生遵循的战略差异，对该节点区域的处理引发了重大争议，尽管近年来趋同程度更高。在东方国家，不进行新辅助治疗的盆腔外侧淋巴结清扫是一种标准做法。相比之下,在西方,偏好倾向于选择放化疗或放疗的新辅助治疗，这将涵盖该区域的治疗，而无需在全直肠系膜切除术中增加这些节点的解剖。在mLLN存在与放射影像学相关的高风险淋巴结特征和对新辅助治疗缺乏反应的情况下，侧方局部复发的风险增加，建议选择适当的策略来降低每个患者的复发风险。尽管针对这一领域的研究具有异质性和回顾性性，国际共识对于统一处理这一临床方案是必要的。
