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01-01-2014 | Colorectal Cancer

Selective Lateral Pelvic Lymph Node Dissection in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy Based on Pretreatment Imaging

Authors: Takashi Akiyoshi, MD, PhD, Masashi Ueno, MD, PhD, Kiyoshi Matsueda, MD, PhD, Tsuyoshi Konishi, MD, PhD, Yoshiya Fujimoto, MD, Satoshi Nagayama, MD, PhD, Yosuke Fukunaga, MD, PhD, Toshiyuki Unno, MD, Atsuhiro Kano, MD, Hiroya Kuroyanagi, MD, PhD, Masatoshi Oya, MD, PhD, Toshiharu Yamaguchi, MD, PhD, Toshiaki Watanabe, MD, PhD, Tetsuichiro Muto, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2014

Abstract

Background

The significance of lateral pelvic lymph node (LPLN) metastasis in advanced low rectal cancer treated with preoperative chemoradiotherapy (CRT) remains unclear. The objective of this study was to evaluate the outcomes of selective LPLN dissection (LPLD) based on the pretreatment imaging in patients with advanced low rectal cancer treated with preoperative CRT.

Methods

We reviewed 127 consecutive patients with clinical stage II–III low rectal cancer below the peritoneal reflection who underwent preoperative CRT and curative resection. LPLD was performed in patients with suspected LPLN metastasis based on MDCT or MRI before CRT (LPLD group, N = 38), and only total mesorectal excision (TME) was performed in patients without suspected LPLN metastasis (TME group, N = 89). Clinical characteristics and the oncological outcome were compared between groups.

Results

The median tumor-to-anal verge distance was 40 mm in both groups. The median maximum long-axis LPLN diameter before CRT was 0 mm in the TME group and 10.5 mm in the LPLD group. Pathological LPLN metastasis was confirmed in 25 patients (66 %) in the LPLD group. Local recurrence at LPLN developed in 3 patients (3.4 %) in the TME group and in none (0 %) of the LPLD group. Multivariate analysis showed that only ypN was an independent prognostic factor for relapse-free survival (RFS), but LPLN metastasis was not associated with poor RFS.

Conclusions

The incidence of LPLN metastasis is high even after preoperative CRT, and LPLD might improve local control and survival of patients with LPLN metastasis in advanced low rectal cancer treated with preoperative CRT.

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Title: Selective Lateral Pelvic Lymph Node Dissection in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy Based on Pretreatment Imaging
Authors: Takashi Akiyoshi, MD, PhD
Masashi Ueno, MD, PhD
Kiyoshi Matsueda, MD, PhD
Tsuyoshi Konishi, MD, PhD
Yoshiya Fujimoto, MD
Satoshi Nagayama, MD, PhD
Yosuke Fukunaga, MD, PhD
Toshiyuki Unno, MD
Atsuhiro Kano, MD
Hiroya Kuroyanagi, MD, PhD
Masatoshi Oya, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Toshiaki Watanabe, MD, PhD
Tetsuichiro Muto, MD, PhD
Publication date: 01-01-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3216-y

At a glance: The STEP trials

Springer Medicine

Selective Lateral Pelvic Lymph Node Dissection in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy Based on Pretreatment Imaging

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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