الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Lymph nodes status is considered a significant prognostic factor in non-metastatic rectal cancer cases. The 8th edition of AJCC recommended that micrometastases to be treated as standard positive nodes. There’s a wide controversy about the management of lateral pelvic nodes in cases of locally advance rectal cancers with a conflict between the Japanese guidelines which supports TME and LLND in management of rectal cancer and the western school which applies pre-operative neoadjuvant therapy and TME without LLND The aim of this study is to detect micrometastases in lateral lymph nodes in operable locally advanced rectal cancers after neoadjuvant therapy This is a prospective study on 30 patients with rectal cancers after receiving neoadjuvant therapy. TME and LLND were performed in all the cases, the dissected lateral lymph nodes were evaluated by hematoxylin and eosin stain to detect any overt metastases and negative lymph nodes were re-evaluated by IHC using ant Pan CK staining. The study included 19 males and 11 females with mean age 50.87±11.85 Pre-neoadjuvant radiological data candidates showed that 13 cases were T3, and 17 cases were T4 with Post neoadjuvant MRI showing downstaging of tumor so that 27 patients became T3 and only 3 (10%) had T4 disease. Pre-neoadjuvant therapy scans showed that 24 patients had suspicious mesorectal lymph nodes, Post-neoadjuvant therapy, the number of patients with suspicious mesorectal nodes dropped to 17. On the other hand, the pre-neoadjuvant radiological assessment of the lateral pelvic lymph nodes revealed that 16 cases had suspicious lateral lymph nodes Post-neoadjuvant downstaging has been observed as well in the lateral pelvic lymph nodes as the number of cases with suspicious lateral nodes dropped to 6. Micrometastases were found in 5 cases and two of them had overt metastases, there were a significant association between presence of micrometastases and pathologically positive mesorectal lymph nodes (P = 0.042) and, a strong relation with enlarged size of LLN pre-neoadjuvant (P = 0.042) and more specifically post-neoadjuvant (P =0.003). from these results, we can say that locally advanced rectal cancers with pre-neoadjuvant or post-neoadjuvant suspicious LLN and clinically pathological mesorectal LNs are to be considered to have lateral pelvic lymph node dissection.