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Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TNM surgery. Implications for treatment decisions

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International Journal of Colorectal Disease Aims and scope Submit manuscript

An Erratum to this article was published on 06 April 2010

Abstract

Background and aims

For rectal carcinoma treated according to the concept of total mesorectal excision (TME surgery), the independent influence of regional lymph node metastasis on the locoregional recurrence risk is still in discussion. A reliable assessment of this risk is important for an individualised selective indication for neoadjuvant radio-/radiochemotherapy.

Methods

Analysis of literature, especially of the last 20 years, and consideration of pathological and oncological basic research. Multivariate analysis of data of the Erlangen Registry of Colorectal Carcinoma.

Results

The clinical assessment of the pretherapeutic regional lymph node status by the present available imaging methods is still unreliable. The analysis of the association between pretherapeutic regional lymph node status and locoregional recurrence risk has to be based on follow-up data of patients treated by primary surgery and has to be distinguished between patients treated by conventional and optimised quality-assured TME surgery, respectively. Data from Erlangen show an increase of the local recurrence risk for patients with at least four involved regional lymph nodes.

Conclusions

For patients with at least four involved regional lymph nodes, a neoadjuvant radiochemotherapy may be indicated. However, today, the pretherapeutic diagnosis is uncertain and results in overtherapy in 40%. Thus, in case of positive lymph node findings by imaging methods, the benefits and risk of neoadjuvant therapy in such situations should always be discussed with the patient in the sense of informed consent and shared decision.

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References

  1. Head RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  Google Scholar 

  2. Büchler MW, Heald RJ, Maurer CA, Ulrich B (eds) (1998) Rektumkarzinom: Das Konzept der Totalen Mesorektalen Exzision. Karger, Basel

    Google Scholar 

  3. Havenga K, Enker WE, Norstein J et al (1999) Improved survival and local control after total mesorectal or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25:368–374

    Article  CAS  PubMed  Google Scholar 

  4. Frileux P, Burdy, Aegerter P et al (2007) Surgical treatment of rectal cancer: results of a strategy for selective preoperative radiotherapy. Gastroenterol Clin Biol 31:934–940

    Article  PubMed  Google Scholar 

  5. Mortensen MM, Khatri VP, Bennett JJ, Petrelli NJ (2007) Total mesorectal excision and pelvic node dissection for rectal cancer: an appraisal. Surg Oncol Clin N Am 16:177–197

    Article  Google Scholar 

  6. Wieder HA, Rosenberg R, Lordick F et al (2007) Rectal cancer: MR imaging before neoadjuvant chemoradiotherapy for prediction of tumor-free circumferential resection margins and long-term survival. Radiology 243:744–751

    Article  PubMed  Google Scholar 

  7. Moser L, Ritz J-P, Hinkelbein W, Höcht S (2008) Adjuvant and neoadjuvant chemoradiation or radiotherapy in rectal cancer—a review focusing on open questions. Int J Colorect Dis 23:227–236

    Article  Google Scholar 

  8. Smith N, Brown G (2008) Preoperative staging of rectal cancer. Acta Oncol 47:20–31

    Article  PubMed  Google Scholar 

  9. Hermanek P, Hohenberger W, Fietkau R, Rödel C (2009) Individualized MRI-based neoadjuvant chemoradiation for middle and lower rectal cancer. Colorectal Disease. doi:10.1111/j.1463-1318.2009.02076.x

  10. Ulrich A, Weitz J, Büchler MW (2009) Strahlentherapie bei Rektumkarzinom: wird zu viel bestrahlt? Chirurg 80:266–273

    Article  CAS  PubMed  Google Scholar 

  11. Merkel S, Meyer T, Göhl J, Hohenberger W (2002) Late locoregional recurrence in rectal carcinoma. Eur J Surg Oncol 28:716–722

    Article  CAS  PubMed  Google Scholar 

  12. UICC (2002) In: Sobin LH, Wittekind Ch (eds) TNM classification of malignant tumours, 6th edn. Wiley, New York

    Google Scholar 

  13. Lahaye MJ, Engelen SME, Nelemans PJ et al (2005) Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Ultrasound CT MRI 26:259–268

    Article  CAS  Google Scholar 

  14. Engelen SME, Beets GL, Beets-Tan RGH (2007) Role of preoperative local and distant staging in rectal cancer. Onkologie 30:141–145

    Article  PubMed  Google Scholar 

  15. Bipat S, Glas AS, Slors FJM et al (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging – A meta-analysis. Radiology 232:773–783

    Article  PubMed  Google Scholar 

  16. Heriot AG, Grundy, Kumar D (1999) Preoperative staging of rectal carcinoma. Br J Surg 86:17–25

    Article  CAS  PubMed  Google Scholar 

  17. Kwok H, Bissett IP, Hill GL (2000) Preoperative staging of rectal cancer. Int J Colorectal Dis 15:9–20

    Article  CAS  PubMed  Google Scholar 

  18. Skandarajah AR, Tjandra JT (2006) Preoperative locoregional imaging in rectal cancer. ANZ J Surg 76:497–504

    Article  PubMed  Google Scholar 

  19. O’Neil BDP, Brown G, Heald RJ et al (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8:625–633

    Article  Google Scholar 

  20. Klessen C, Rogalla P, Taupitz M (2007) Local staging of rectal cancer: the current role of MRI. Eur Radiol 17:379–389

    Article  PubMed  Google Scholar 

  21. Fujita S, Yamamoto S, Akasu T, Moriya Y (2008) Outcome of patients with clinical stage II or III rectal cancer treated without adjuvant radiotherapy. Int J Colorect Dis 23:1073–1079

    Article  Google Scholar 

  22. Beets-Tan R, Beets GL (2008) MRI and lymph node staging in rectal cancer. Abstract. Eur J Surg Oncol 34:1002

    Google Scholar 

  23. Engelen S, Lahaye MJ, Beets-Tan RG et al (2008) Tailored treatment of primary rectal cancer based on MRI: does it reduce the number of incomplete resections? Abstract. Ann Oncol 19(Suppl):i17

    Article  Google Scholar 

  24. Lahaye MJ, Engelen SME, Kessels AGH et al (2008) USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology 246:804–811

    Article  PubMed  Google Scholar 

  25. Kim CK, Kim SH, Choi D (2007) Comparison between 3-T magnetic resonance imaging and multi-detector row computed tomography for the preoperative evaluation of rectal cancer. J Comput Assist Tomogr 31:853–859

    Article  PubMed  Google Scholar 

  26. Kulinna C, Scheidler J, Strauss T et al (2004) Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound. J Comput Assist Tomogr 28:123–130

    Article  PubMed  Google Scholar 

  27. Sinha R, Verma R, Rajesh A, Richards CJ (2006) Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol 61:924–931

    Article  CAS  PubMed  Google Scholar 

  28. Taylor A, Slater A, Mapstone N et al (2007) Staging rectal cancer: MRI compared to MDCT. Abdom Imaging 32:323–327

    Article  PubMed  Google Scholar 

  29. Japanese Society for Cancer of the Colon and Rectum (1997) Japanese classification of colorectal carcinoma (Response assessment of nonsurgical treatment for colorectal carcinoma), 1st Engl edn. Kanehara & Co Ltd, Tokyo, pp 4–5

    Google Scholar 

  30. Arii K, Takifuji K, Yokoyama S et al (2006) Preoperative evaluation of pelvic lateral lymph nodes of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients. Langenbecks Arch Surg 391:449–454

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Potential benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245:80–87

    Article  PubMed  Google Scholar 

  33. Morson BC, Vaughan EG, Bussey JHR (1963) Pelvic recurrence after excision of rectum for carcinoma. Brit Med J ii:13–18

    Article  Google Scholar 

  34. Phillips RKS, Hittinger R, Bleskovsky L et al (1984) Local recurrence following ‘curative’ surgery for large bowel cancer. II. The rectum and sigmoid. Br J Surg 71:17–20

    Article  CAS  PubMed  Google Scholar 

  35. Jass JR, Atkin WS, Cuzick J et al (1986) The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 10:437–459

    Article  CAS  PubMed  Google Scholar 

  36. Rinnert-Gongora S, Tartter PI (1989) Multivariate analysis of recurrence after anterior resection for colorectal carcinoma. Am J Surg 157:573–576

    Article  CAS  PubMed  Google Scholar 

  37. Zirngibl H, Husemann B, Hermanek P (1990) Intraoperative spillage of tumor cells in surgery for rectal cancer. Dis Colon Rectum 33:610–614

    Article  CAS  PubMed  Google Scholar 

  38. McCall JL, Cox MR, Wattchow DA (1995) Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorect Dis 10:126–132

    Article  CAS  Google Scholar 

  39. Park YJ, Park KJ, Park J-G et al (1999) Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 23:721–729

    Article  CAS  PubMed  Google Scholar 

  40. Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334

    Article  CAS  PubMed  Google Scholar 

  41. Ross A, Rusnak C, Weinerman B et al (1999) Recurrence and survival after surgical management of rectal cancer. Am J Surg 177:392–395

    Article  CAS  PubMed  Google Scholar 

  42. Law WL, Ho JWC, Chan R et al (2005) Outcome of anterior resection for stage II rectal cancer without radiation: role of adjuvant chemotherapy. Dis Colon Rectum 48:218–226

    Article  PubMed  Google Scholar 

  43. Chok KSH, Law WL (2007) Prognostic factors affecting survival and recurrences of patients with pT1 and pT2 colorectal cancer. World J Surg 31:1485–1490

    Article  PubMed  Google Scholar 

  44. Akasu T, Takawa M, Yamamoto S et al (2008) Intersphincteric resection for very low rectal adenocarcinoma. Univariate and multivariate analyses of risk factors for recurrence. Ann Surg Oncol 15:2668–2676

    Article  PubMed  Google Scholar 

  45. Eriksen MT, Wibe A, Haffner J, Wiig JN, on behalf of the Norwegian Rectal Cancer Group (2007) Prognostic groups in 1676 patients with T3 rectal cancer treated without preoperative radiotherapy. Dis Colon Rectum 50:156–167

    Article  PubMed  Google Scholar 

  46. Bufalari A, Roselli C, Giustozzi G, Moggi L (2000) Locally advanced rectal cancer: a multivariate analysis of outcome risk factors. J Surg Oncol 74:2–10

    Article  CAS  PubMed  Google Scholar 

  47. Rödel C, Martus P, Papadopoulos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696, correspondence 24(2006):1319

    Article  PubMed  Google Scholar 

  48. Larsen SG, Wiig JN, Dueland S, Giercksky K-E (2008) Prognostic factors after preoperative irradiation and surgery for locally advanced rectal cancer. Eur J Surg Oncol 34:410–417

    CAS  PubMed  Google Scholar 

  49. Astler CB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–852

    Article  CAS  PubMed  Google Scholar 

  50. Dukes CE, Bussey HJR (1958) The spread of rectal cancer and its effect on prognosis. Br J Cancer 12:309–320

    CAS  PubMed  Google Scholar 

  51. Moran MR, James EC, Rothenberger DA, Goldberg SM (1992) Prognostic value of positive nodes in rectal cancer. Dis Colon Rectum 35:579–581

    Article  CAS  PubMed  Google Scholar 

  52. Cecil TD, Sexton R, Moran BJ, Heald RJ (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 47:1145–1150

    Article  PubMed  Google Scholar 

  53. Mori T, Takahashi T, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbeck’s Arch Surg 383:409–415

    Article  CAS  Google Scholar 

  54. Takahashi T, Ueno M, Azekura K, Ohta H (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43:859–868

    Google Scholar 

  55. Koda K, Saito N, Oda K et al (2004) Evaluation of lateral lymph node dissection with preoperative chemo-radiotherapy for the treatment of advanced middle to lower rectal cancers. Int J Colorect Dis 19:188–194

    Article  CAS  Google Scholar 

  56. Shimoyama M, Yamazaki T, Suda T, Hatakeyama K (2003) Prognostic significance of lateral lymph node micrometastases in lower rectal cancer. An immunohistochemical study with CAM5.2. Dis Colon Rectum 46:333–339

    Article  PubMed  Google Scholar 

  57. Hara M, Tirai T, Nakanishi H et al (2007) Isolated tumor cell in lateral lymph node has no influence on the prognosis of rectal cancer patients. Int J Colorect Dis 22:911–917

    Article  CAS  Google Scholar 

  58. Wang Cc, Zhou Z-G, Yu Y-Y et al (2007) Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer. Eur J Surg Oncol 33:463–467

    Article  CAS  PubMed  Google Scholar 

  59. 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 92:756–763

    Article  CAS  PubMed  Google Scholar 

  60. Shiozawa M, Akaike M, Yamada R et al (2007) Lateral lymph node dissection for lower rectal cancer. Hepato-Gastroenterol 54:1066–1070

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  62. Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32:128–133

    Article  CAS  PubMed  Google Scholar 

  63. Hojo K, Vernava AM, Sugihara K, Katumata K (1991) Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum 34:532–539

    Article  CAS  PubMed  Google Scholar 

  64. Enker WE (1992) Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127:1396–1402

    CAS  PubMed  Google Scholar 

  65. Moriya Y, Sugihara K, Akasu T, Fujita S (1995) Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma (with special reference to loco-regional recurrence). Dis Colon Rectum 38:1162–1168

    Article  CAS  PubMed  Google Scholar 

  66. Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880

    Article  CAS  PubMed  Google Scholar 

  67. Harnsberger JR, Vernava AM III, Longo WE (1994) Radical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical treatment of rectal cancer. Dis Colon Rectum 37:73–87

    Article  CAS  PubMed  Google Scholar 

  68. MacFarlane JK (1997) Lateral node dissection—a critique. In: Soreide O, Norstein J (eds) Rectal cancer surgery. Optimisation–standardisation–documentation. Springer, Berlin Heidelberg New York, pp 255–263

    Google Scholar 

  69. Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal surgery. J Natl Cancer Inst 93:583–596

    Article  CAS  PubMed  Google Scholar 

  70. Bruch H-P, Schwandner O (2002) Die totale mesorektale Exzision beim Rektumkarzinom—das Dissektionsprinzip ohne kontrollierte Daten. Viszeralchirurgie 37:6–11

    Article  Google Scholar 

  71. Koch M, Kienle P, Antolovic D et al (2005) Is the lateral lymph node compartment relevant? Recent Results Cancer Res 165:40–45

    Article  PubMed  Google Scholar 

  72. Crawshaw A, Hennigan R, Smedley FH, Leslie MD (2003) Perioperative radiotherapy for rectal cancer: the case for a selective pre-operative approach-the third way. Colorectal Disease 5:367–372

    Article  CAS  PubMed  Google Scholar 

  73. Burton S, Brown G, Daniels I et al (2006) MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Brit J Cancer 94:351–357

    Article  CAS  PubMed  Google Scholar 

  74. Chau I, Brown G, Cunningham D et al (2006) Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic-resonance imaging-defined poor risk rectal cancer. J Clin Oncol 24:668–674, discussion 4664–4666

    Article  CAS  PubMed  Google Scholar 

  75. Junginger Th, Hermanek P, Oberholzer K, Schmidberger H (2006) Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation. Zentralbl Chir 131:275–284

    PubMed  Google Scholar 

  76. Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) S3-Leitlinie “Kolorektales Karzinom”—Aktualisierung 2008. Ergebnis einer evidenzbasierten Konsensuskonferenz (8–9.Juni 2007). Z Gastroenterol 46:799–840

    Article  CAS  PubMed  Google Scholar 

  77. Strassburg J, Junginger T, Trinh T et al (2008) Magnetic resonance imaging (MRI)-based indication for neoadjuvant treatment of rectal carcinoma and the surrogate endpoint CRM status. Int J Colorect Dis 23:1099–1107

    Article  Google Scholar 

  78. Nagawa H, Muto T, Sunouchi K et al (2001) Randomized controlled trial of lateral node dissection vs nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44:1274–1280

    Article  CAS  PubMed  Google Scholar 

  79. Watanabe T, Tsurita G, Muto T et al (2002) Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery 132:27–33

    Article  PubMed  Google Scholar 

  80. Kusunoki M, Inoue Y (2007) Current surgical management of rectal cancer. Dig Surg 24:115–119

    Article  PubMed  Google Scholar 

  81. Libuti SK, Tepper JE, Saltz LB, Rustgi AK (2005) Cancer of the rectum. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer. Principles & practice of oncology, 7th edn. Lippincott, Williams & Wilkins, Philadelphia, pp 1110–1125

    Google Scholar 

  82. Wiggers T, van de Velde CJH (2002) The circumferential margin in rectal cancer: recommendations based on the Dutch Total Mesorectal Excision Study. Eur J Cancer 38:973–976

    Article  CAS  PubMed  Google Scholar 

  83. Pahlman L (2005) Indications for long-term radiotherapy. In: Büchler MW, Heald RJ, Ulrich B, Weitz J (eds) Rectal cancer treatment. Recent Results Cancer Research 165:212–220

    Article  Google Scholar 

  84. MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. Br Med J 333:779–784

    Article  Google Scholar 

  85. Brown G, Daniels IR (2005) Preoperative staging of rectal cancer: the MERCURY research project. Recent Results Cancer Res 165:58–74

    Article  CAS  PubMed  Google Scholar 

  86. Daugherty CK (2005) Ethical issues. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer. Principles & practice in oncology, 7th edn. Lippincott, Williams & Wilkins, Philadelphia, pp 2747–2758

    Google Scholar 

  87. Ubel PA (2006) Patient decision making. In: Chang AE, Ganz PA, Hayes DF et al (eds) Oncology. An evidence-based approach. Springer Science, New York, pp 177–183

    Google Scholar 

  88. Glas AS, Lijmer JG, Prins MH et al (2003) The diagnostic odds ratio. A single indicator of test performance. J Clin Epidemiol 56:1129–1135

    Article  PubMed  Google Scholar 

  89. Kim NK, Kim MJ, Park JK et al (2000) Preoperative staging of rectal cancer with MRI, accuracy and usefulness. Ann Surg Oncol 7:732–737

    Article  CAS  PubMed  Google Scholar 

  90. Botterill ID, Blunt DM, Quirke P et al (2001) Evaluation of the role of preoperative magnetic resonance imaging in the management of rectal cancer. Colorectal Dis 3:295–303

    Article  CAS  PubMed  Google Scholar 

  91. Gagliardi G, Bayar S, Smith R, Salem RR (2002) Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg 137:447–451

    Article  PubMed  Google Scholar 

  92. Brown G, Radcliffe AG, Newcombe RG et al (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90:355–364

    Article  CAS  PubMed  Google Scholar 

  93. Matsuoka H, Nakamura A, Masaki T et al (2003) A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma. Amer J Surg 185:556–559

    Article  PubMed  Google Scholar 

  94. Branagan G, Chave H, Fuller C et al (2004) Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? Dis Colon Rectum 47:1317–1322

    Article  PubMed  Google Scholar 

  95. Oberholzer K, Junginger T, Kreitner KF et al (2005) Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MR imaging using an integrated parallel acquisition technique. JMRI 22:101–108

    Article  PubMed  Google Scholar 

  96. Ferri M, Laghi A, Mingazzini P et al (2006) Pre-operative assessment of extramural invasion and sphincteral involvement in rectal cancer by magnetic resonance imaging with phase-array coil. Colorectal Dis 7:387–393

    Article  Google Scholar 

  97. Kim CK, Kim SH, Chun HK et al (2006) Preoperative staging of rectal cancer: accuracy of 3-Tesla magnetic resonance imaging. Eur Radiol 16:972–980

    Article  PubMed  Google Scholar 

  98. Adeyemo D, Hutchinson R (2009) Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT. Colorect Dis 11:259–263

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University Hospital, Krankenhausstr. 12, 91054, Erlangen, Germany

    Paul Hermanek, Susanne Merkel & Werner Hohenberger

  2. Department of Radiotherapy, University Hospital, Erlangen, Germany

    Rainer Fietkau

  3. Department of Radiotherapy and Oncology, University Hospital, Frankfurt/Main, Germany

    Claus Rödel

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  1. Paul Hermanek
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  2. Susanne Merkel
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Correspondence to Paul Hermanek.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00384-010-0932-7

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Hermanek, P., Merkel, S., Fietkau, R. et al. Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TNM surgery. Implications for treatment decisions. Int J Colorectal Dis 25, 359–368 (2010). https://doi.org/10.1007/s00384-009-0864-2

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