Details

Autor(en) / Beteiligte

• Bell, S.
• Sasaki, J.
• Sinclair, G.
• Chapuis, P. H.
• Bokey, E. L.

Titel

Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues

Ist Teil von

• Colorectal disease, 2009-06, Vol.11 (5), p.443-449

Ort / Verlag

Oxford, UK: Blackwell Publishing Ltd

Erscheinungsjahr

2009

Quelle

Wiley Online Library All Journals

Beschreibungen/Notizen

• Objective  This paper reviews the literature on the pathways of lymphatic drainage of the rectum and their significance in radical cancer surgery. Method  This paper reviews some of the seminal works on the lymphatic drainage of the rectum and its surgical implications when operating on patients with rectal cancer. Publications were searched via Medline, sourced from reference lists and by cross referencing with the most widely cited papers. Results  The classical European description of the anatomy of the lymphatic drainage of the rectum is presented. Early lymphatic mapping techniques and the role of newer technologies in lymphatic mapping, including sentinel lymph node mapping are discussed. The differing philosophies between Western practice, of dissection in the plane of the fascia propria and the Japanese wider pelvic lymphadenectomy are discussed. Conclusions  A clear understanding of the regional lymphatic drainage of the rectum and precise anatomical mobilisation of the rectum is the surgical cornerstone to excellent locoregional control of rectal cancer. The success of the differing Western and Japanese philosophies on the degree of pelvic lymphadenectomy suggests a possible role for ‘selective wide pelvic lymphadectomy’. Mapping lateral lymphatic drainage pathways could augment the selection process for radiotherapy.