CA S E R E P O R T Open Access
Lateral lymph node metastasis in a patient
with T1 upper rectal cancer treated by
lateral lymph node dissection: a case report
and brief literature review
, Masamichi Kimura
, Toshiji Tominaga
, Shinji Iwakura
, Yoshihiko Hoshida
and Tetsuya Horiuchi
Background: Lateral lymph node (LLN) metastasis may occur in patients with advanced rectal cancers of which the
lower margins are located at or below the peritoneal reflection. However, LLN metastasis from a T1 rectal cancer is
rare. Here, we report a case of LLN metastasis from a T1 upper rectal cancer that was successfully treated by
sequential LLN dissection.
Case presentation: A 56-year-old man was referred to our hospital for the treatment of a T1 upper rectal cancer.
We performed a laparoscopic low anterior resection. Histological examination showed a moderately differentiated
adenocarcinoma with submucosal layer invasion; the invasion depth was classified as head invasion, without vessel
or lymph duct invasion. Tumor budding was classified as grade 1. A total of six lymph nodes were harvested, and
no lymph node metastases were detected. The postoperative course was uneventful. At 6 months after surgery,
however, the serum carcinoembryonic antigen levels were elevated, and abdominal computed tomography (CT)
revealed swollen lymph nodes in the right internal and common iliac artery area. Positron emission tomography
with CT revealed hot spots in the same lesions. A retrospective re-evaluation of the preoperative CT images
revealed no apparent swollen lymph nodes; however, an unusual soft tissue area was detected around the right
internal iliac artery. A right LLN dissection was performed. Fifteen lymph nodes were resected, and histologically,
metastases of adenocarcinoma were identified in 3 nodes. The postoperative course was again uneventful. The
patient was given 12 cycles of adjuvant chemotherapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin).
The patient remains healthy and with no signs of recurrence at 30 months after the second surgery.
Conclusions: LLN metastasis occurs very rarely in patients with T1 upper rectal cancer and no risk factors for lymph
node metastasis; however, a careful perioperative examination of the LLN should be performed. In cases involving
LLN metastasis, a LLN dissection may be a therapeutic option if performed with curative intent.
Keywords: Lateral lymph node metastasis, T1 upper rectal cancer, Lateral lymph node dissection,
* Correspondence: firstname.lastname@example.org
Department of Surgery, National Hospital Organization, Osaka Minami
Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
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Tanishima et al. Surgical Case Reports (2017) 3:93