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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

  • Colorectal Cancer
  • Published:
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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.

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Acknowledgment

Support for statistical analysis was provided by the Medical Research Collaborating Center, Seoul National University Bundang Hospital, Korea.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    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

  2. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Ji Hoon Park MD, Young Hoon Kim MD, PhD & Kyung Ho Lee MD, PhD

  3. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Jae-Sung Kim MD, PhD

  4. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Jin Won Kim MD & Jee Hyun Kim MD, PhD

  5. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Tae-Young Chang MD, Sung-Chan Park MD, PhD, Dae Kyung Sohn MD, PhD & Jae Hwan Oh MD, PhD

  6. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Ji Won Park MD, Seung-Bum Ryoo MD, Seung-Yong Jeong MD, PhD & Kyu Joo Park MD, PhD

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  1. Heung-Kwon Oh MD
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  2. Sung-Bum Kang MD, PhD
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  9. Kyung Ho Lee MD, PhD
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  10. Jae-Sung Kim MD, PhD
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  14. Sung-Chan Park MD, PhD
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  16. Jae Hwan Oh MD, PhD
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  20. Kyu Joo Park MD, PhD
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Corresponding author

Correspondence to Sung-Bum Kang MD, PhD.

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On behalf of the Seoul Colorectal Group (SECOG).

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Oh, HK., Kang, SB., Lee, SM. et al. 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. Ann Surg Oncol 21, 2280–2287 (2014). https://doi.org/10.1245/s10434-014-3559-z

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  • DOI: https://doi.org/10.1245/s10434-014-3559-z

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