Skip to main content
Top
Published in: Surgery Today 6/2014

01-06-2014 | Original Article

Survival benefit of lateral lymph node dissection according to the region of involvement and the number of lateral lymph nodes involved

Authors: Shozo Yokoyama, Katsunari Takifuji, Tsukasa Hotta, Kenji Matsuda, Takashi Watanabe, Yasuyuki Mitani, Junji Ieda, Hiroki Yamaue

Published in: Surgery Today | Issue 6/2014

Login to get access

Abstract

Purpose

The effectiveness of lateral lymph node dissection for extending the survival of patients with advanced lower rectal cancer remains unclear. The purpose of this study was to clarify the survival benefit of lateral lymph node dissection according to the region of involvement and the number of lateral lymph nodes involved.

Methods

We reviewed 131 consecutive patients with advanced lower rectal cancer, who had undergone curative resection with total mesorectal excision plus extended lateral lymph node dissection at Wakayama Medical University Hospital. Twenty-six (19.1 %) of these patients had lateral lymph involvement. We performed univariate and multivariate analyses for the 3-year disease-free and overall survival of these patients.

Results

Multivariate analysis revealed that the number (>1) and the region (common iliac artery region or external iliac artery region) of lateral lymph node metastasis are independent predictive factors for recurrence and survival. The Kaplan–Meier analysis demonstrated that patients with one lymph node metastasis in the internal iliac artery or obturator region had better survival.

Conclusions

Lateral lymph node dissection resulted in survival benefit for patients with single lateral lymph node involvement in the internal iliac artery region or the obturator region.
Literature
1.
go back to reference Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg. 1994;81:7–19.PubMedCrossRef Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg. 1994;81:7–19.PubMedCrossRef
2.
go back to reference Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356:93–6.PubMedCrossRef Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356:93–6.PubMedCrossRef
3.
go back to reference Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.PubMedCrossRef Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.PubMedCrossRef
4.
go back to reference Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181:335–46.PubMed Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181:335–46.PubMed
5.
go back to reference Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg. 1996;83:375–9.PubMedCrossRef Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg. 1996;83:375–9.PubMedCrossRef
7.
go back to reference Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.PubMedCrossRef Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.PubMedCrossRef
8.
go back to reference Wu ZY, Wan J, Li JH, Zhao G, Yao Y, Du JL, et al. Prognostic value of lateral lymph node metastasis for advanced low rectal cancer. World J Gastroenterol. 2007;13:6048–52.PubMedCrossRef Wu ZY, Wan J, Li JH, Zhao G, Yao Y, Du JL, et al. Prognostic value of lateral lymph node metastasis for advanced low rectal cancer. World J Gastroenterol. 2007;13:6048–52.PubMedCrossRef
9.
go back to reference Shimomura M, Ikeda S, Takakura Y, Kawaguchi Y, Tokunaga M, Egi H, et al. Adequate lymph node examination is essential to ensure the prognostic value of the lymph node ratio in patients with stage III colorectal cancer. Surg Today. 2011;41:1370–9.PubMedCrossRef Shimomura M, Ikeda S, Takakura Y, Kawaguchi Y, Tokunaga M, Egi H, et al. Adequate lymph node examination is essential to ensure the prognostic value of the lymph node ratio in patients with stage III colorectal cancer. Surg Today. 2011;41:1370–9.PubMedCrossRef
10.
go back to reference Stelzner F. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery. Langenbecks Arch Surg. 1999;384:405–8.PubMedCrossRef Stelzner F. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery. Langenbecks Arch Surg. 1999;384:405–8.PubMedCrossRef
11.
go back to reference 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 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
12.
go back to reference Hida J, Yasutomi M, Fujimoto K, Maruyama T, Okuno K, Shindo K. Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg. 1997;184:475–80.PubMed Hida J, Yasutomi M, Fujimoto K, Maruyama T, Okuno K, Shindo K. Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg. 1997;184:475–80.PubMed
13.
go back to reference Ueno H, Mochizuki H, Hashiguchi Y, Hase K. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg. 2001;234:190–7.PubMedCentralPubMedCrossRef Ueno H, Mochizuki H, Hashiguchi Y, Hase K. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg. 2001;234:190–7.PubMedCentralPubMedCrossRef
14.
go back to reference Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43:S59–68.PubMedCrossRef Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43:S59–68.PubMedCrossRef
15.
go back to reference Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 1989;32:307–15.PubMedCrossRef Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 1989;32:307–15.PubMedCrossRef
16.
go back to reference Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.PubMedCrossRef Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.PubMedCrossRef
17.
go back to reference Mori T, Takahashi K, Yasuno M. 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. Langenbecks Arch Surg. 1998;383:409–15.PubMedCrossRef Mori T, Takahashi K, Yasuno M. 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. Langenbecks Arch Surg. 1998;383:409–15.PubMedCrossRef
18.
go back to reference Fujita S, Yamamoto S, Akasu T, Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg. 2003;90:1580–5.PubMedCrossRef Fujita S, Yamamoto S, Akasu T, Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg. 2003;90:1580–5.PubMedCrossRef
19.
go back to reference Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52:567–76.PubMedCrossRef Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52:567–76.PubMedCrossRef
20.
go back to reference Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255:1129–34.PubMedCrossRef Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255:1129–34.PubMedCrossRef
21.
go back to reference Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Miyoshi M, Kajiwara 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 Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Miyoshi M, Kajiwara 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.
go back to reference Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, 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 Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, 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
23.
go back to reference Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.PubMedCrossRef Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.PubMedCrossRef
24.
go back to reference Kim JC, Takahashi K, Yu CS, Kim HC, Kim TW, Ryu MH, et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007;246:754–62.PubMedCrossRef Kim JC, Takahashi K, Yu CS, Kim HC, Kim TW, Ryu MH, et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007;246:754–62.PubMedCrossRef
25.
go back to reference Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.PubMedCrossRef Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.PubMedCrossRef
26.
go back to reference Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.PubMedCrossRef Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.PubMedCrossRef
Metadata
Title
Survival benefit of lateral lymph node dissection according to the region of involvement and the number of lateral lymph nodes involved
Authors
Shozo Yokoyama
Katsunari Takifuji
Tsukasa Hotta
Kenji Matsuda
Takashi Watanabe
Yasuyuki Mitani
Junji Ieda
Hiroki Yamaue
Publication date
01-06-2014
Publisher
Springer Japan
Published in
Surgery Today / Issue 6/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-013-0815-y

Other articles of this Issue 6/2014

Surgery Today 6/2014 Go to the issue