直肠癌侧方淋巴结清扫:争议解析与精准决策OA

Lateral lymph node metastasis represents a significant pattern of local spread in mid-to-low locally advanced rectal cancer.Currently,a notable"binary opposition"exists in the international diagnosis and treatment landscape.The Eastern paradigm,represented by Japan,classifies lateral lymph nodes as regional nodes and advocates for prophylactic dissection in cT3-4 stages.In contrast,Western guidelines(NCCN/ESMO)consider lateral lymph node dissection(LLND)as overtreatment and recommend neoadjuvant chemoradiotherapy as an alternative.The core of the debate focuses on the anatomical definition of lateral lymph nodes,the necessity of prophylactic dissection,the limitations of neoadjuvant chemoradiotherapy efficacy,and the balance between functional preservation and the extent of dissection.With advancements in magnetic resonance imaging,minimally invasive surgical techniques(laparoscopy/robotics),and neoadjuvant therapies,precision diagnosis and treatment are becoming feasible.Future breakthroughs lie in constructing individualized risk stratification models,applying intraoperative navigation technologies,and promoting prospective clinical trials through multidisciplinary collaboration,aiming to transition from opposition to integration and achieve dual enhancements in patient survival and quality of life.