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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2014

01-07-2014 | Colorectal Cancer

Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study

Authors: Heung-Kwon Oh, MD, Sung-Bum Kang, MD, PhD, Sung-Min Lee, MD, Soo Young Lee, MD, Myoung Hun Ihn, MD, Duck-Woo Kim, MD, PhD, Ji Hoon Park, MD, Young Hoon Kim, MD, PhD, Kyung Ho Lee, MD, PhD, Jae-Sung Kim, MD, PhD, Jin Won Kim, MD, Jee Hyun Kim, MD, PhD, Tae-Young Chang, MD, Sung-Chan Park, MD, PhD, Dae Kyung Sohn, MD, PhD, Jae Hwan Oh, MD, PhD, Ji Won Park, MD, Seung-Bum Ryoo, MD, Seung-Yong Jeong, MD, PhD, Kyu Joo Park, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2014

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Abstract

Background

Although lateral pelvic node dissection (LPND) is recommended for rectal cancer with clinically metastatic lateral pelvic lymph nodes (LPNs), LPNs may respond to neoadjuvant chemoradiotherapy (nCRT). Our aim was to determine the optimal indication for LPND after nCRT for mid/low rectal cancer.

Methods

Of 2,263 patients with clinical stage II/III mid/low rectal cancer who were managed at three tertiary referral hospitals, 66 patients underwent curative surgery including LPND after nCRT were included in this study. Risk factors for LPN metastasis were retrospectively analyzed and oncologic outcomes determined according to LPN response to nCRT.

Results

Persistent LPNs greater than 5 mm on post-nCRT magnetic resonance imaging were significantly associated with residual tumor metastasis, unlike responsive LPN after nCRT (short-axis diameter ≤5 mm) (pathologically, 61.1 % [22 of 36] vs. 0 % [0 of 30], P < 0.001). Multivariable analysis revealed post-nCRT LPN size as a significant and independent risk factor for LPN metastasis (odds ratio 2.390; 95 % confidence interval 1.104–4.069). Over a median follow-up of 39.3 months, the recurrence rate was lower in patients with responsive nodes than in patients with persistent nodes (20 % [6 of 30] vs. 47.2 % [17 of 36], P = 0.012). The 5-year overall survival and 5-year disease-free survival rates were lower in patients with persistent LPN than in patients with responsive LPN (44.6 % vs. 77.1 %, P = 0.034; 33.7 % vs. 72.5 %, P = 0.011, respectively).

Conclusions

In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.
Literature
1.
Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.PubMedCrossRef
2.
Georgiou P, Tan E, Gouvas N, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10:1053–62.PubMedCrossRef
3.
Heriot AG, Byrne CM, Lee P, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum. 2008;51:284–91.PubMedCrossRef
4.
Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013;56:535–50.PubMedCrossRef
5.
6.
Shihab OC, Taylor F, Bees N, et al. Relevance of magnetic resonance imaging–detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98:1798–804.PubMedCrossRef
7.
Nagawa H, Muto T, Sunouchi K, 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;44:1274–80.PubMedCrossRef
8.
Fujita S, Akasu T, Mizusawa J, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13:616–21.PubMedCrossRef
9.
Koch M, Kienle P, Antolovic D, Buchler MW, Weitz J. Is the lateral lymph node compartment relevant? Recent Results Cancer Res. 2005;165:40–5.PubMedCrossRef
10.
Wang Z, Loh KY, Tan KY, Woo EC. The role of lateral lymph node dissection in the management of lower rectal cancer. Langenbecks Arch Surg. 2012;397:353–61.PubMedCrossRef
11.
Kim TH, Jeong SY, Choi DH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008;15:729–37.PubMedCrossRef
12.
Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–7.
13.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRef
14.
van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82.PubMedCrossRef
15.
Watanabe T, Tsurita G, Muto T, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.PubMedCrossRef
16.
Kusters M, Beets GL, van de Velde CJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249:229–35.PubMedCrossRef
17.
Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11:637–45.PubMedCrossRef
18.
Kim YH, Kim DY, Kim TH, 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;62:761–8.PubMedCrossRef
19.
Kim SH, Lee JY, Lee JM, Han JK, Choi BI. Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol. 2011;21:987–95.PubMedCrossRef
20.
Kim MJ, Kim KG, Lee JH, et al. Analysis of the anatomical characteristics of the pelvis in Koreans to aid in development of a NOTES platform. Surg Innov. 2013;20:134–41.PubMedCrossRef
21.
Ueno H, Mochizuki H, Hashiguchi Y, et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007;245:80–7.PubMedCentralPubMedCrossRef
22.
Matsuoka H, Nakamura A, Masaki T, et al. Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res. 2007;27(5B):3529–33.PubMed
23.
Moriya Y, Sugihara K, Akasu T, Fujita S. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg. 1997;21:728–32.PubMedCrossRef
24.
Kyo K, Sameshima S, Takahashi M, Furugori T, Sawada T. Impact of autonomic nerve preservation and lateral node dissection on male urogenital function after total mesorectal excision for lower rectal cancer. World J Surg. 2006;30:1014–9.PubMedCrossRef
25.
Edge SB, Byrd DR, Compton CC, Fritz AG. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.
26.
Liang JT. Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg Oncol. 2011;18:153–9.PubMedCrossRef
27.
Park JS, Choi GS, Lim KH, et al. Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience. Surg Endosc. 2011;25:3322–9.PubMedCrossRef
28.
Beaumont C, Pandey T, Gaines Fricke R, Laryea J, Jambhekar K. (2013) MR evaluation of rectal cancer: current concepts. Curr Probl Diagn Radiol. 2013;42:99–112.CrossRef
29.
Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–7.PubMedCrossRef
30.
Min BS, Kim JS, Kim NK, et al. Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis. Ann Surg Oncol. 2009;16:3271–8.PubMedCrossRef
31.
Beets-Tan RG, Lambregts DM, Maas M, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2013;23:2522–31.PubMedCrossRef
32.
Koda K, Saito N, Oda K, Takiguchi N, Sarashina H, Miyazaki M. Evaluation of lateral lymph node dissection with preoperative chemo-radiotherapy for the treatment of advanced middle to lower rectal cancers. Int J Colorectal Dis. 2004;19:188–94.PubMedCrossRef
33.
Mann B. Lateral lymph node dissection in rectal cancer patients: is there any indication? Int J Colorectal Dis. 2004;19:195–6.PubMedCrossRef
34.
Yano H, Moran BJ. The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg. 2008;95:33–49.PubMedCrossRef
35.
Quadros CA, Falcao MF, Carvalho ME, Ladeia PA, Lopes A. Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol. 2012;106:653–8.PubMedCrossRef
36.
Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S59–68.PubMedCrossRef
37.
Uyama I, Sugioka A, Matsui H, et al. Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer. J Am Coll Surg. 2001;193:579–84.PubMedCrossRef
Metadata
Title
Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study
Authors
Heung-Kwon Oh, MD
Sung-Bum Kang, MD, PhD
Sung-Min Lee, MD
Soo Young Lee, MD
Myoung Hun Ihn, MD
Duck-Woo Kim, MD, PhD
Ji Hoon Park, MD
Young Hoon Kim, MD, PhD
Kyung Ho Lee, MD, PhD
Jae-Sung Kim, MD, PhD
Jin Won Kim, MD
Jee Hyun Kim, MD, PhD
Tae-Young Chang, MD
Sung-Chan Park, MD, PhD
Dae Kyung Sohn, MD, PhD
Jae Hwan Oh, MD, PhD
Ji Won Park, MD
Seung-Bum Ryoo, MD
Seung-Yong Jeong, MD, PhD
Kyu Joo Park, MD, PhD
Publication date
01-07-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 7/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3559-z

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