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Langenbeck's Archives of Surgery

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01-08-2006 | Original Article

Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens

Authors: K. Maschuw, R. Kress, A. Ramaswamy, I. Braun, P. Langer, B. Gerdes

Published in: Langenbeck's Archives of Surgery | Issue 4/2006

Abstract

Background and aims

The Union Internationale Contre le Cancer and American Joint Committee on Cancer classification propose that pN₀-classified colorectal lymphadenectomy specimens will ordinarily include 12 or more tumor-negative lymph nodes. We performed a clinical trial to investigate whether a short-term preoperative radiotherapy (5×5 Gy) leads to a reduction of the number of lymph nodes in rectal cancer specimens after total and partial mesorectal excision (TME and PME, respectively).

Materials and methods

Within a 5-year period, 28 (15%) of 148 rectal cancer patients underwent hypofractionated preoperative radiotherapy in this monocenter study, whereas 120 patients (85%) underwent TME/PME surgery alone. The main criterion was the number of lymph nodes in TME/PME specimens. We used a stratified one-sided Wilcoxon–Mann–Whitney test to test for a significant difference in the number of lymph nodes, stratifying for tumor location and postoperative tumor stage. Patients who were suspected of having any alterations in the number of pelvic lymph nodes were excluded from the study.

Results

Fewer lymph nodes were detected in the TME/PME specimens of patients who received hypofractionated preoperative radiotherapy compared to patients who underwent TME/PME surgery alone (12 detectable lymph nodes vs 15; p=0.0005). Tumor location (p=0.095) and tumor stage (p=0.093) did not significantly influence the number of lymph nodes in this study.

Conclusions

We conclude that a 5×5 Gy short-term preoperative radiotherapy leads to a reduction in the number of lymph nodes in TME/PME specimens. Because neoadjuvant therapy in rectal cancer for T₂ and T₃ tumors has advanced a new therapeutic standard procedure, in the future, less lymph nodes will be detected in TME/PME specimens. This might influence the required number of lymph nodes in current staging systems for rectal cancer in the future.

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Title: Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens
Authors: K. Maschuw
R. Kress
A. Ramaswamy
I. Braun
P. Langer
B. Gerdes
Publication date: 01-08-2006
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2006
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-006-0056-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens

Abstract

Background and aims

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Materials and methods

Results

Conclusions

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