Journal of the Anus, Rectum and Colon
Online ISSN : 2432-3853
ISSN-L : 2432-3853
Original Research Article
Lateral Pelvic Recurrence in Rectal Cancer Is Not Local Recurrence but Lymphatic Metastasis
Shigeo TodaNaoko InoshitaShuichiro MatobaYusuke MaedaKosuke HiramatsuYudai FukuiYutaka HanaokaMasashi UenoHiroya KuroyanagiFumihiko IshikawaKenichi Ohashi
Author information
JOURNAL OPEN ACCESS

2025 Volume 9 Issue 2 Pages 225-236

Details
Abstract

Objectives: Complete resection of advanced rectal cancer is challenging, with local recurrence rates ranging from 4% to 12%. Local recurrence is often categorized as central, anastomotic, or lateral, with lateral lymph node (LLN) metastasis being the primary driver of lateral recurrence. Although preoperative radiotherapy effectively manages nonlateral recurrences, it is less effective for lateral recurrences, and LLN dissection significantly reduces lateral recurrence rates. This study aimed to clarify the clinicopathological characteristics associated with lateral and nonlateral recurrences.

Methods: We retrospectively analyzed 232 patients (156 males and 76 females; median age, 64 years) who underwent preoperative radiotherapy followed by curative-intent surgery for clinical T3/4 rectal adenocarcinoma located below the peritoneal reflection between April 2010 and December 2017. In total, 40% of the patients underwent LLN dissection. Univariate and multivariate analyses of clinicopathological data were performed to identify the independent risk factors for lateral and nonlateral recurrences.

Results: Local recurrence occurred in 19 (8%) patients: 7 had lateral recurrence, 13 had nonlateral recurrence, and 1 had both. Multivariate analysis identified mesorectal lymph node metastasis as a significant risk factor for lateral recurrence, whereas positive circumferential resection margin was a significant risk factor for nonlateral recurrence.

Conclusions: The identification of different risk factors for lateral and nonlateral recurrence suggests that lateral recurrence is more strongly associated with lymphatic permeation than nonlateral recurrence. These findings highlight the importance of LLN dissection in minimizing the risk of lateral recurrence.

Fullsize Image
Content from these authors
© 2025 The Japan Society of Coloproctology

JARC is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Anyone may download, reuse, copy, reprint, or distribute articles published in the Journal for non-profit purposes if they cite the original authors and source properly. If anyone remixes, transforms, or builds upon the material, you may not distribute the modified material.
https://creativecommons.org/licenses/by-nc-nd/4.0/
Previous article Next article
feedback
Top