Background:Management of lateral pelvic lymph node (LPLN) metastasis in advanced lower rectal cancer has historically exemplified a fundamental East–West divide. In Japan, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) considers LPLN metastasis a regional manifestation requiring lateral pelvic lymph node dissection (LPLND). In contrast, Western practice has long approached LPLN disease as systemic, prioritizing neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) without additional lateral clearance.Recent Advances:Evidence generated from the JCOG0212 trial and subsequent multicenter cohorts has firmly demonstrated that LPLND markedly reduces lateral local recurrence, particularly in patients with radiologically enlarged nodes. These findings have contributed to a paradigm shift: the 2025 European Society for Medical Oncology (ESMO) Guidelines now endorse selective LPLND for suspicious nodes following neoadjuvant therapy, indicating an emerging convergence between Eastern surgical philosophy and Western multimodal treatment strategies.Surgical Innovation:Robotic surgery has transformed the technical execution of LPLND. Its stable, high-definition three-dimensional visualization, wristed instruments, and enhanced precision enable meticulous dissection across four anatomically defined planes: the medial plane (uretero-hypogastric fascia), intermediate plane (vesico-hypogastric fascia), lateral plane (pelvic sidewall), and dorsal plane (pelvic floor and lumbosacral trunk/sacral plexus). These features facilitate consistent nerve-sparing surgery, reduce blood loss, and improve postoperative urinary and sexual function compared with conventional laparoscopy or open approaches. Robotic LPLND therefore represents a contemporary synthesis of Eastern surgical precision and Western evidence-based multimodal therapy—offering an integrated pathway toward optimized oncologic control and enhanced functional outcomes.
背景：晚期低位直肠癌的侧方盆腔淋巴结（LPLN）转移处理，历来体现了东西方理念的根本分歧。在日本，日本大肠癌研究会（JSCCR）将LPLN转移视为区域性病变，主张进行侧方盆腔淋巴结清扫术（LPLND）。相比之下，西方医学界长期将LPLN疾病视为全身性病变，优先采用新辅助放化疗（nCRT）联合全直肠系膜切除术（TME），而不进行额外的侧方清扫。 最新进展：JCOG0212试验及后续多中心队列研究提供的证据明确表明，LPLND能显著降低侧方局部复发率，尤其对于影像学显示淋巴结肿大的患者。这些发现促成了治疗范式的转变：2025年欧洲肿瘤内科学会（ESMO）指南现已推荐在新辅助治疗后对可疑淋巴结进行选择性LPLND，这标志着东方外科理念与西方多模式治疗策略正逐步趋同。 外科创新：机器人手术革新了LPLND的技术实施。其稳定、高清的三维视野，腕式器械和更高的操作精度，使得外科医生能够在四个解剖学定义的层面进行精细解剖：内侧平面（输尿管-下腹筋膜）、中间平面（膀胱-下腹筋膜）、外侧平面（盆腔侧壁）和背侧平面（盆底及腰骶干/骶丛）。与传统腹腔镜或开放手术相比，这些技术特点有助于实现稳定的神经保留手术，减少术中出血，并改善术后泌尿和性功能。因此，机器人LPLND代表了东方外科精准理念与西方循证多模式治疗的当代融合——为优化肿瘤控制和提升功能预后提供了一条整合路径。
肿瘤(癌症)患者之家