Top

International Journal of Colorectal Disease

Published in:

01-12-2013 | Original Article

Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy

Authors: Seok-Byung Lim, Chang Sik Yu, Chan Wook Kim, Yong Sik Yoon, Seong Ho Park, Tae Won Kim, Jong Hoon Kim, Jin Cheon Kim

Published in: International Journal of Colorectal Disease | Issue 12/2013

Abstract

Purpose

To identify the indication and prognostic significance of lateral lymph node (LLN) excision in locally advanced rectal cancer patients underwent preoperative chemoradiotherapy.

Methods

Included were 67 consecutive patients with suspicious LLN metastasis who underwent chemoradiotherapy and surgery including selective LLN excision (82 excisions). The excisions were grouped according to the presence of LLN metastasis and compared in terms of the clinicopathological findings and oncological results. The correlation between the largest short-axis diameter of LLN measured by imaging and metastasis rates was explored.

Results

LLN metastases were identified in 32 excisions (40.0 %). The calculated short-axis LLN diameter predicting metastasis was 11.7 mm (before chemoradiotherapy) and 11.4 mm (before surgery). LLN metastasis was observed more frequently in the low rectum (p = 0.031) and associated with higher CEA levels (p = 0.048). The 3-year overall survival rates for patients with and without LLN metastasis were 60.3 % and 90.3 % (p = 0.048), while the 3-year disease-free survival rates were 31.4 % and 70.5 % (p = 0.009). The hazard ratio of LLN metastasis for recurrence was 2.938 (95 % CI = 1.258–6.863).

Conclusions

LLN metastasis in rectal cancer patients underwent chemoradiotherapy was a distinct poor prognostic factor. Selective LLN excision based on imaging studies may have a role for such patients.

Engstrom PF, Arnoletti JP, Benson AB 3rd et al. (2012) The NCCN clinical practice guidelines in oncology, version 4.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.

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

Garcia-Aguilar J, Cromwell JW, Marra C et al (2001) Treatment of locally recurrent rectal cancer. Dis Colon Rectum 44:1743–1748PubMedCrossRef

Das P, Skibber JM, Rodriguez-Bigas MA et al (2006) Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 29:219–224PubMedCrossRef

Hida J, 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

Takahashi T, Ueno M, Azekura K et al (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43(suppl 10):S59–S68PubMedCrossRef

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

Kim TH, Jeong SY, Choi DH et al (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15:729–737PubMedCrossRef

Moriya Y, Sugihara K, Akasu T et al (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21:728–732PubMedCrossRef

10.

Enker WE, Thaler HT, Cranor ML et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed

11.

Kusters M, Beets GL, van de Velde CJ 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 249:229–235PubMedCrossRef

12.

Kim JC, Takahashi K, Yu CS et al (2007) Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 246:754–762PubMedCrossRef

13.

Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354PubMedCrossRef

14.

Kim JH, Beets GL, Kim MJ et al (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83PubMedCrossRef

15.

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

16.

Youden WJ (1950) Index for rating diagnostic test. Cancer 3:32–35PubMedCrossRef

17.

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

18.

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

19.

Kusters M, Wallner C, Lange MM et al (2010) Origin of presacral local recurrence after rectal cancer treatment. Br J Surg 97:1582–1587PubMedCrossRef

20.

Konishi T, Watanabe T, Nagawa H et al (2010) Preoperative chemoradiation and extended pelvic lymphadenectomy for rectal cancer: two distinct principles. World J Gastrointest Surg 27:95–100CrossRef

21.

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 44:1274–1280PubMedCrossRef

22.

Williams AD, Cousins C, Soutter WP et al (2001) Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography. AJR Am J Roentgenol 177:343–348PubMedCrossRef

23.

Matsuoka H, Nakamura A, Masaki T et al (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27:3529–3534PubMed

24.

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

25.

Yano H, Moran BJ, Watanabe T et al (2010) Lateral pelvic lymph-node dissection: still an option for cure. Lancet Oncol 11:114PubMedCrossRef

Title: Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy
Authors: Seok-Byung Lim
Chang Sik Yu
Chan Wook Kim
Yong Sik Yoon
Seong Ho Park
Tae Won Kim
Jong Hoon Kim
Jin Cheon Kim
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 12/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1761-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2013

Severe intestinal toxicity after stereotactic ablative radiotherapy for abdominopelvic malignancies

Laterally spreading tumors of the colorectum: clinicopathologic features and malignant potential by macroscopic morphology

Hemi-levator excision to provide greater sphincter preservation in low rectal cancer

F-18 FDG PET/CT in the assessment of patients with unexplained CEA rise after surgical curative resection for colorectal cancer

Intestinal permeability, systemic endotoxemia, and bacterial translocation after open or laparoscopic resection for colon cancer: a prospective randomized study.

Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis—a comparison of stoma reversal rates