直肠癌侧方淋巴结清扫的研究进展与相关争议

盆腔侧方淋巴结（lateral pelvic lymph node，LPLN）是中低位直肠癌常见的淋巴回流通路，有14%～30%的局部中晚期直肠癌患者同时合并LPLN转移。然而，术前诊断的遗漏和不规范的治疗是导致术后LPLN复发的常见原因，同时也是诊疗中的难点之一。目前，侧方淋巴结清扫术（lateral pelvic lymph node dissection，LPLND）的价值与意义，在国际上尚存争议。近些年来，新辅助放化疗（neoadjuvant chemoradiotherapy，nCRT）与LPLND相互替代的治疗模式趋于融合，逐渐形成了一套精确化、个体化的治疗策略。同时，随着外科器械设备的更新与淋巴结示踪剂技术的不断发展，使得以往制约LPLND的因素逐渐消失，可逐渐在临床推广开展。但针对直肠癌LPLN转移的治疗策略、nCRT后LPLND的适应证、预后价值、有效清扫范围、安全性仍存在诸多问题，需深入研究。 

Research progress and related controversies on lateral lymph node dissection for the management of rectal cancer

The lateral pelvic lymph node (LPLN) is a common lymphatic drainage pathway for middle-low rectal cancer. Approximately 14%-30% of patients with locally advanced rectal cancer have LPLN metastasis. However, the omission of a preoperative diagnosis and non-standard treatment cause postoperative LPLN recurrence and may cause difficulties in the diagnosis and treatment of cancer. The value and significance of lateral pelvic lymph node dissection (LPLND) remain controversial in eastern and western countries. In recent years, alternative treatment models of neoadjuvant chemoradiotherapy (nCRT) and LPLND have been integrated, and a set of precise and individualized treatment strategies has been developed. With the development of novel surgical instruments, equipment, and lymph node tracer technology, factors restricting LPLND application have gradually disappeared, resulting in widespread use in clinical practice. However, numerous issues regarding treatment strategies, LPLND indications, prognostic value, effective cleaning range, and safety of LPLND in patients with rectal cancer require further research.