Annals of Surgical Oncology

, Volume 11, Issue 2, pp 187–191

Residual Mesorectal Lymph Node Involvement Following Neoadjuvant Combined-Modality Therapy: Rationale for Radical Resection?

  • Francesco Stipa
  • Alma Zernecke
  • Harvey G. Moore
  • Bruce D. Minsky
  • W. Douglas Wong
  • Martin Weiser
  • Philip B. Paty
  • Jinru Shia
  • Jose G. Guillem
Original Articles

DOI: 10.1245/ASO.2004.06.010

Cite this article as:
Stipa, F., Zernecke, A., Moore, H.G. et al. Ann Surg Oncol (2004) 11: 187. doi:10.1245/ASO.2004.06.010

Abstract

Background: In order to evaluate the impact of preoperative radiation and chemotherapy (combined modality therapy, or CMT) on primary rectal cancer and mesorectal lymph nodes (MLNs), middle and lower third rectal cancers were resected with total mesorectal excision (TME) and assessed for frequency of MLN retrieval and residual MLN involvement.

Methods: Between 1990 and 2001, 187 consecutive patients underwent abdominoperineal resection (APR) or low anterior resection (LAR) for locally advanced (endorectal ultrasound [ERUS] stage, T3–4) mid and distal rectal cancer following preoperative CMT. Sphincter preservation was possible in 150 patients (80%). The mean number of retrieved MLNs was 10.6. Pre-CMT ERUS stage was compared with final pathologic stage.

Results: Comparison of pre-CMT ERUS stage with pathologic stage revealed a decrease in T stage in 93 patients (49%), as well as a decrease in the percentage of individuals with positive MLNs, from 54% to 27% (P < .0001). The overall incidence of positive MLN involvement was 27%, and incidence paralleled pathologic T stage (pT): pT0 = 7%, pT1 = 8%, pT2 = 22%, pT3 = 37%, and pT4 = 67%.

Conclusions: Following preoperative CMT, the incidence of residual MLN involvement remains significant and parallels increasing pT stage. Therefore, the standard of care for locally advanced distal rectal cancer should continue to include formal rectal resection (TME).

Key Words

Mesorectal lymph nodes Radiotherapy Rectal cancer Staging 

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Francesco Stipa
    • 1
  • Alma Zernecke
    • 1
  • Harvey G. Moore
    • 1
  • Bruce D. Minsky
    • 2
  • W. Douglas Wong
    • 1
  • Martin Weiser
    • 1
  • Philip B. Paty
    • 1
  • Jinru Shia
    • 3
  • Jose G. Guillem
    • 1
    • 2
  1. 1.Colorectal Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew York
  2. 2.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew York
  3. 3.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew York
  4. 4.New York

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