A dispute over lateral lymph node dissection in lower rectal cancer

Lateral lymph node dissection for lower rectal cancer varies a lot in its extent, indication and effect between surgeons in different countries or background. It is commonly believed that patients with tumor in lower rectal, high grade or T3-4 invasion should be the candidate for lateral lymph node dissection, in whom a radionuclide image, endosonography and PET-CT can be utilized for evaluating the lymph node status preoperatively. Lateral lymph node dissection should be proceeded by a proficient and skill-full surgeon, for whom dissection should be carried on along the space between intra-iliac vessels, pelvic wall and obturator facial plane until the obturator nerve is exposed. The number of lymph nodes dissection for pathological examination should be at least 10. Up to now, the effect of lateral lymph node dissection to decrease the local recurrence rate has been confirmed worldwide, but its necessity is still controversial and debated by large clinical trails. From the author’s view, lateral node dissection for lower rectal cancer is valuable and efficient. Modified or elective lateral node dissection with TME or even in laparoscopy may be a prospective direction in the future for the treatment of patients with lower rectal cancer.