Lateral pelvic lymph node dissection in the management of locally advanced low rectal cancer

The management of rectal cancer has seen major developments over the last few decades (1) with increasing use of pre-operative imaging for local staging, more clear role for neoadjuvant chemoradiotherapy (nCRT) (2) and standardization of radical local resection with total mesorectal excision (TME) surgery which resulted in reduction of local recurrence rate to less than 10% (3). However, it has been increasingly recognized that patients with locally advanced low rectal cancer represent a particular challenge in terms of local disease control (4). This subgroup of patients is now known to have lateral pelvic lymph node (LPLN) metastasis in 15% to 20% which results in poor survival rates due to an increased risk of local and distant recurrence (5).