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01-03-2017 | Original Scientific Report

Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases

Authors: Toshiya Nagasaki, Takashi Akiyoshi, Yoshiya Fujimoto, Tsuyoshi Konishi, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

Published in: World Journal of Surgery | Issue 3/2017

Abstract

Background

Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced low rectal cancer (LALRC). However, the prognostic significance of CRT in patients with lateral lymph node metastasis (LLNM) is unknown. The present study aimed to examine the prognostic impact of preoperative CRT in patients with LALRC and LLNM.

Methods

We retrospectively analyzed data for 73 patients with LALRC and LLNM who underwent total mesorectal excision and lateral lymph node dissection from 1985 to 2012. The patient population was divided into a CRT group (n = 30) who received preoperative CRT and a surgery alone group (n = 43) who were treated without CRT.

Results

The 5-year overall survival (OS), 5-year relapse-free survival (RFS), and 5-year local recurrence (LR) rates were significantly better in the CRT group (78.2, 72.1, and 3.5 %, respectively) compared with the surgery alone group (41.1, 25.4, and 39.6 %, respectively). There were fewer total, mesorectal, and LLNMs in the CRT group compared with the surgery alone group. Multivariate analysis showed that surgery without CRT was an independent predictor of poorer OS (hazard ratio [HR] 3.513, p = 0.004), RFS (HR 2.696, p = 0.021), and LR rates (HR 11.094, p = 0.001). A total number of lymph node metastases ≥4 were also an independent predictor of poorer OS and RFS.

Conclusions

Preoperative CRT might have a significant prognostic impact on patients with LALRC with LLNM treated with total mesorectal excision and lateral lymph node dissection.

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMed

Bosset J-F, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMed

Collette L, Bosset JF, Den Dulk M et al (2007) Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European organisation for research and treatment of cancer rad. J Clin Oncol 25:4379–4386CrossRefPubMed

Cripps H (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish rectal cancer trial. N Engl J Med 336:980–987CrossRef

Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650CrossRefPubMed

Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed

Van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582CrossRefPubMed

Sauer I, Bacon HE (1952) A new approach for excision of carcinoma of the lower portion of the rectum and anal canal. Surg Gynecol Obstet 95:229–242PubMed

Takahashi T, Ueno M, Azekura K et al (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43:S59–S68CrossRefPubMed

10.

Fujita S, Yamamoto S, Akasu T et al (2012) Prognostic factors of rectal cancer patients with lateral pelvic lymph node metastasis. Hepatogastroenterology 59:2494–2497PubMed

11.

Ueno M, Oya M, Azekura K et al (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763CrossRefPubMed

12.

Kinugasa T, Akagi Y, Shirouzu K (2014) Benefit of lateral lymph node dissection for rectal cancer: long-term analysis of 944 cases undergoing surgery at a single center (1975–2004). Anticancer Res 34:4633–4639PubMed

13.

Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255:1129–1134CrossRefPubMed

14.

Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672CrossRefPubMed

15.

Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29CrossRefPubMed

16.

Watanabe T, Itabashi M, Shimada Y et al (2015) Japanese society for cancer of the colon and rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20:207–239CrossRefPubMedPubMedCentral

17.

Kusters M, van de Velde CJH, Beets-Tan RGH et al (2009) Patterns of local recurrence in rectal cancer: a single-center experience. Ann Surg Oncol 16:289–296CrossRefPubMed

18.

Kusters M, Beets GL, van de Velde CJH et al (2009) A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg 249:229–235CrossRefPubMed

19.

Georgiou P, Tan E, Gouvas N et al (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053–1062CrossRefPubMed

20.

Akiyoshi T, Ueno M, Matsueda K et al (2014) Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol 21:189–196CrossRefPubMed

21.

Konishi T, Kuroyanagi H, Oya M et al (2011) Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc 25:2358–2359CrossRefPubMed

22.

Akiyoshi T, Matsueda K, Hiratsuka M et al (2015) Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative chemoradiotherapy in patients with advanced low-rectal cancer. Ann Surg Oncol 22(Suppl 3):614–620CrossRef

23.

Ueno H, Mochizuki H, Hashiguchi Y et al (2001) Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 234:190–197CrossRefPubMedPubMedCentral

24.

Hida JI, Yasutomi M, Fujimoto K et al (1997) Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg 184:475–480PubMed

25.

Fujita S, Yamamoto S, Akasu T et al (2009) Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis 24:1085–1090CrossRefPubMed

26.

Brown G (2011) Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg 98:1798–1804CrossRefPubMed

27.

Dharmarajan S, Shuai D, Fajardo AD et al (2011) Clinically enlarged lateral pelvic lymph nodes do not influence prognosis after neoadjuvant therapy and TME in stage III rectal cancer. J Gastrointest Surg 15:1368–1374CrossRefPubMed

28.

Kim MJ, Kim TH, Kim DY et al (2015) Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol 111:459–464CrossRefPubMed

29.

Kim TG, Park W, Choi DH et al (2014) Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. Int J Colorectal Dis 29:193–200CrossRefPubMed

30.

Joern F, Gunter H, Thomas J et al (2015) Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades. Int J Colorectal Dis 30:797–806CrossRefPubMed

31.

Ishiguro M, Higashi T, Watanabe T et al (2014) Changes in colorectal cancer care in japan before and after guideline publication: a nationwide survey about D3 lymph node dissection and adjuvant chemotherapy. J Am Coll Surg 218(969–977):e1

Title: Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases
Authors: Toshiya Nagasaki
Takashi Akiyoshi
Yoshiya Fujimoto
Tsuyoshi Konishi
Satoshi Nagayama
Yosuke Fukunaga
Masashi Ueno
Publication date: 01-03-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3748-y

At a glance: The STEP trials

Springer Medicine

Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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