Top

Published in:

01-03-2008 | Gastrointestinal Oncology

Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated with Preoperative Chemoradiotherapy and Curative Resection

Authors: Tae Hyun Kim, MD, Seung-Yong Jeong, MD, Dong Hyun Choi, MD, Dae Yong Kim, MD, Kyung Hae Jung, MD, Sung Ho Moon, MD, Hee Jin Chang, MD, Seok-Byung Lim, MD, Hyo Seong Choi, MD, Jae-Gahb Park, MD

Published in: Annals of Surgical Oncology | Issue 3/2008

Abstract

Background

In rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection, we evaluated the effect of clinical parameters on lateral pelvic recurrence and made an attempt to identify a risk factor for lateral pelvic recurrence.

Methods

The study involved 366 patients who underwent preoperative CRT and curative resection between October 2001 and December 2005. Clinical parameters such as gender, age, tumor size, histologic type, cT and cN classification, ypT and ypN classification, circumferential resection margin, tumor regression grade, chemotherapeutic regimen, and lateral lymph node size were analyzed to identify risk factors associated with lateral pelvic recurrence.

Results

Of the 366 patients, 29 patients (7.9%) had locoregional recurrence: 6 (20.7%) with central pelvic recurrence and 24 (82.7%) had lateral pelvic recurrence, of which 1 had simultaneous central and lateral pelvic recurrence. Multivariate analysis showed that ypN classification and lateral lymph node size were significantly associated with lateral pelvic recurrence (P < .001). Of 250 ypN0 patients, lateral pelvic recurrence developed in 1.4%, 2.9%, and 50% of patients with lateral lymph node sizes of <5, 5-9.9, and ≥10 mm, respectively (P < .001). Of 116 ypN+ patients, lateral pelvic recurrence developed in 4.3%, 35.7%, and 87.5% of patients with lateral lymph node sizes of <5, 5–9.9, and ≥10 mm, respectively (P < .001).

Conclusions

In our study, lateral pelvic recurrence was a major cause of locoregional recurrence, and ypN+ and lateral lymph node size were risk factors for lateral pelvic recurrence.

Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181:335–46PubMed

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9PubMedCrossRef

Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999; 25:368–74PubMedCrossRef

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638–46PubMedCrossRef

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40PubMedCrossRef

Garcia-Aguilar J, Cromwell JW, Marra C, Lee SH, Madoff RD, Rothenberger DA. Treatment of locally recurrent rectal cancer. Dis Colon Rectum 2001; 44:1743–8PubMedCrossRef

Temple WJ, Saettler EB. Locally recurrent rectal cancer: role of composite resection of extensive pelvic tumors with strategies for minimizing risk of recurrence. J Surg Oncol 2000; 73:47–58PubMedCrossRef

Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002; 235:449–57PubMedCrossRef

Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2002; 89:327–34PubMedCrossRef

10.

Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982; 144:350–4PubMedCrossRef

11.

Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, et al. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum 1994; 37:219–23PubMedCrossRef

12.

Hall NR, Finan PJ, al-Jaberi T, Tsang CS, Brown SR, Dixon MF, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 1998; 41:979–83PubMedCrossRef

13.

Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 2000; 43:S59–68PubMedCrossRef

14.

Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 2005; 92:756–63PubMedCrossRef

15.

Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984; 53:1354–62PubMedCrossRef

16.

Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983; 52:1317–29PubMedCrossRef

17.

Suzuki K, Muto T, Sawada T. Prevention of local recurrence by extended lymphadenectomy for rectal cancer. Surg Today 1995; 25:795–801PubMedCrossRef

18.

Sato H, Maeda K, Maruta M, Masumori K, Koide Y. Who can get the beneficial effect from lateral lymph node dissection for dukes C rectal carcinoma below the peritoneal reflection? Dis Colon Rectum 2006; 49:S3–S12PubMedCrossRef

19.

Hida J, Yasutomi M, Fujimoto K, Maruyama T, Okuno K, Shindo K. Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg 1997; 184:475–80PubMed

20.

Sugihara K, Moriya Y, Akasu T, Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 1996; 78:1871–80PubMedCrossRef

21.

Ueno H, Mochizuki H, Hashiguchi Y, Hase K. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 2001; 234:190–7PubMedCrossRef

22.

Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 2001; 44:1274–80PubMedCrossRef

23.

Kim YH, Kim DY, Kim TH, Jung KH, Chang HJ, Jeong SY, et al. Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer. Int J Radiat Oncol Biol Phys 2005; 62:761–8PubMedCrossRef

24.

Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 2004; 52:78–83PubMedCrossRef

25.

Greene FL, American Joint Committee on Cancer, American Cancer Society. AJCC Cancer Staging Manual, 6th ed., New York: Springer-Verlag, 2002

26.

Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 1997; 12:19–23PubMedCrossRef

27.

Blomqvist L, Rubio C, Holm T, Machado M, Hindmarsh T. Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen. Br J Radiol 1999; 72:18–23PubMed

28.

Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92:205–16PubMedCrossRef

29.

Wiig JN, Carlsen E, Soreide O. Mesorectal excision for rectal cancer: a view from Europe. Semin Surg Oncol 1998; 15:78–86PubMedCrossRef

30.

Enker WE. Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 1992; 127:1396–401; discussion 402PubMed

31.

Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer. World J Surg 1992; 16:848–57PubMedCrossRef

32.

Ueno H, Yamauchi C, Hase K, Ichikura T, Mochizuki H. Clinicopathological study of intrapelvic cancer spread to the iliac area in lower rectal adenocarcinoma by serial sectioning. Br J Surg 1999; 86:1532–7PubMedCrossRef

33.

Fujita S, Yamamoto S, Akasu T, Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 2003; 90:1580–5PubMedCrossRef

34.

Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery 2002; 132:27–33PubMedCrossRef

35.

Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001; 93:583–96PubMedCrossRef

36.

Liersch T, Langer C, Ghadimi BM, Kulle B, Aust DE, Baretton GB, et al. Lymph node status and TS gene expression are prognostic markers in stage II/III rectal cancer after neoadjuvant fluorouracil-based chemoradiotherapy. J Clin Oncol 2006; 24:4062–8PubMedCrossRef

37.

Stocchi L, Nelson H, Sargent DJ, O’Connell MJ, Tepper JE, Krook JE, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol 2001; 19:3895–902PubMed

38.

Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004; 232:773–83PubMedCrossRef

Title: Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated with Preoperative Chemoradiotherapy and Curative Resection
Authors: Tae Hyun Kim, MD
Seung-Yong Jeong, MD
Dong Hyun Choi, MD
Dae Yong Kim, MD
Kyung Hae Jung, MD
Sung Ho Moon, MD
Hee Jin Chang, MD
Seok-Byung Lim, MD
Hyo Seong Choi, MD
Jae-Gahb Park, MD
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9696-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated with Preoperative Chemoradiotherapy and Curative Resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2008

Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?

In Reply

Breast Conservation Therapy: Multiple Reexcisions or Subcutaneous and Nipple-Sparing Mastectomy?

Analysis of Risk Factors of Predictive Local Tumor Control in Oral Cavity Cancer

Expression Status of Folate Receptor α Is Significantly Correlated with Prognosis in Non-Small-Cell Lung Cancers

A Novel Function of the Receptor for Advanced Glycation End-Products (RAGE) in Association with Tumorigenesis and Tumor Differentiation of HCC