LAUSR

nosis with the interval between initial treatment of the primary tumour and diagnosis of ILN. Tocchi et al. found the only parameter with a statistically significant correlation with survival was interval to diagnosis, with better survival in the metachronous group, defined as metastases within 12 months. However, this association is not a universal finding. Hamano et al. found that metachronous ILN metastasis carried a worse prognosis. Not surprisingly, there are no clear guidelines for the management of isolated ILN metastasis. Johnson et al. showed that systemic chemotherapy and radiotherapy is a non-curative strategy. Adachi et al. reported survival benefit from surgical treatment in a case series of four patients diagnosed with isolated metachronous ILN metastasis from rectal carcinoma, with all patients alive at 3 years. Isolated metachronous ILN metastases from rectal cancer are rare. We recommend thorough exclusion of distant disease. Discussion in a multidisciplinary meeting can help clarify the role of adjuvant therapy. There is some evidence supporting groin dissection with survival benefit over chemoradiotherapy alone. In patients deemed suitable for groin dissection, we suggest a proactive approach to the management of groin incisions and lymphoedema risk.