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The review contrasts Japan’s lateral pelvic lymph node dissection (LPLND) approach with Western reliance on neoadjuvant chemoradiotherapy and total mesorectal excision. Evidence from the JCOG0212 trial supports selective LPLND to reduce lateral pelvic recurrence, and guideline positions are converging. Robotic surgery further improves technical execution through 3D visualization, wristed instruments, and plane-based nerve-sparing dissection, aiming to enhance oncologic control and postoperative urinary and sexual function.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/robotic-lateral-pelvic-lymph-node-dissection-for-advanced-rectal-cancer-bridging-eastern-surgical-precision-and-western-multimodal-strategy/464444/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/robotic-lateral-pelvic-lymph-node-dissection-for-advanced-rectal-cancer-bridging-eastern-surgical-precision-and-western-multimodal-strategy/464444.png","ImageObject",300,407,{"name":92,"@type":93},"Logic","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main East–West difference in managing lateral pelvic lymph node metastasis?","Question",{"text":112,"@type":113},"In Japan, LPLN metastasis is treated as a regional extension with lateral pelvic lymph node dissection, whereas Western practice has typically relied on neoadjuvant chemoradiotherapy followed by total mesorectal excision without routine additional lateral clearance.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What evidence supports the use of selective LPLND after neoadjuvant therapy?",{"text":117,"@type":113},"The review highlights results from the JCOG0212 trial, showing that LPLND can significantly reduce lateral local recurrence, particularly for patients with radiologically enlarged nodes, leading to guideline endorsement of selective LPLND.",{"name":119,"@type":110,"acceptedAnswer":120},"How does robotic surgery improve LPLND outcomes compared with conventional approaches?",{"text":121,"@type":113},"Robotic surgery provides stable, high-definition 3D visualization and wristed instruments that enable precise dissection across defined anatomical planes, supporting nerve-sparing surgery and helping reduce blood loss while improving postoperative urinary and sexual function versus laparoscopy or open surgery.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},464444,1790832783,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":56,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","Review  \nRobotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer: Bridging Eastern Surgical Precision and Western Multimodal Strategy  \nDai Shida   \nAcademic Editor: Luca Roncucci  \nReceived: 26 November 2025  \nRevised: 16 December 2025  \nAccepted: 24 December 2025  \nPublished: 26 December 2025  \nCopyright: © 2025 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDivision of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo 1088639, Japan; [dshida@g.ecc.u-tokyo.ac.jp](dshida@g.ecc.u-tokyo.ac.jp); Tel.: +81-3-3443-8111; Fax: +81-3-5449-5604  \nSimple Summary  \nManagement of lateral pelvic lymph node (LPLN) metastasis in advanced lower rectal cancer has long differed between Japan and Western countries. In Japan, LPLN metastasis is regarded as a regional extension that can be surgically removed by lateral lymph node dissection (LPLND), whereas Western practice has relied mainly on chemoradiotherapy. Recent clinical evidence, including the JCOG0212 trial, has demonstrated that LPLND can significantly reduce local pelvic recurrence in selected patients. With these findings, Western guidelines have begun to recognize selective LPLND as a valid option, reflecting a growing convergence between Eastern and Western strategies. The introduction of robotic surgery has further enhanced the precision and safety of LPLND, minimizing functional complications while maintaining oncologic radicality. This review summarizes the evolution of global LPLND practice and highlights how robotic technology may bridge East–West differences in the multidisciplinary management of advanced rectal cancer.  \nAbstract  \nBackground: 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 threedimensional 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  \nWestern evidence-based multimodal therapy—offering an integrated pathway toward optimized oncologic control and enhanced functional outcomes.  \nKeywords: lateral pelvic lymph node; lateral pelvic lymph node dissection; nerve preservation; rectal cancer; robotic surgery; urinary function  \n1. Introduction  \nLateral pelvic lymph node (LPLN) metastasis ","cbCaipEWY2nTZQ95","https://ap.wps.com/l/cbCaipEWY2nTZQ95","pdf",2561562,"English","# Simple Summary\n# Abstract\n# 1. Introduction\n## East–West differences in lateral pelvic management\n## Reassessment after the JCOG0212 trial\n## Robotic surgery and technical advantages\n## Recent guideline updates","[{\"question\":\"What is the main East–West difference in managing lateral pelvic lymph node metastasis?\",\"answer\":\"In Japan, LPLN metastasis is treated as a regional extension with lateral pelvic lymph node dissection, whereas Western practice has typically relied on neoadjuvant chemoradiotherapy followed by total mesorectal excision without routine additional lateral clearance.\"},{\"question\":\"What evidence supports the use of selective LPLND after neoadjuvant therapy?\",\"answer\":\"The review highlights results from the JCOG0212 trial, showing that LPLND can significantly reduce lateral local recurrence, particularly for patients with radiologically enlarged nodes, leading to guideline endorsement of selective LPLND.\"},{\"question\":\"How does robotic surgery improve LPLND outcomes compared with conventional approaches?\",\"answer\":\"Robotic surgery provides stable, high-definition 3D visualization and wristed instruments that enable precise dissection across defined anatomical planes, supporting nerve-sparing surgery and helping reduce blood loss while improving postoperative urinary and sexual function versus laparoscopy or open surgery.\"}]","Robotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer - Bridging Eastern Surgical Precision and Western Multimodal Strategy | PDF",1790768204,48]