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Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases

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Abstract

Background

Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced low rectal cancer (LALRC). However, the prognostic significance of CRT in patients with lateral lymph node metastasis (LLNM) is unknown. The present study aimed to examine the prognostic impact of preoperative CRT in patients with LALRC and LLNM.

Methods

We retrospectively analyzed data for 73 patients with LALRC and LLNM who underwent total mesorectal excision and lateral lymph node dissection from 1985 to 2012. The patient population was divided into a CRT group (n = 30) who received preoperative CRT and a surgery alone group (n = 43) who were treated without CRT.

Results

The 5-year overall survival (OS), 5-year relapse-free survival (RFS), and 5-year local recurrence (LR) rates were significantly better in the CRT group (78.2, 72.1, and 3.5 %, respectively) compared with the surgery alone group (41.1, 25.4, and 39.6 %, respectively). There were fewer total, mesorectal, and LLNMs in the CRT group compared with the surgery alone group. Multivariate analysis showed that surgery without CRT was an independent predictor of poorer OS (hazard ratio [HR] 3.513, p = 0.004), RFS (HR 2.696, p = 0.021), and LR rates (HR 11.094, p = 0.001). A total number of lymph node metastases ≥4 were also an independent predictor of poorer OS and RFS.

Conclusions

Preoperative CRT might have a significant prognostic impact on patients with LALRC with LLNM treated with total mesorectal excision and lateral lymph node dissection.

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Author contributions

TN and TA contributed to the conception and design of the study. All authors acquired, analyzed, and interpreted the data. All authors contributed to drafting the article and to its critical revision. All authors read and approved the final version.

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    Authors and Affiliations

    1. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

      Toshiya Nagasaki, Takashi Akiyoshi, Yoshiya Fujimoto, Tsuyoshi Konishi, Satoshi Nagayama, Yosuke Fukunaga & Masashi Ueno

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    1. Toshiya Nagasaki
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    2. Takashi Akiyoshi
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    3. Yoshiya Fujimoto
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    4. Tsuyoshi Konishi
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    5. Satoshi Nagayama
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    6. Yosuke Fukunaga
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    7. Masashi Ueno
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    Correspondence to Takashi Akiyoshi.

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    All authors have no conflicts of interest or financial ties to disclose in association with this study.

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    Toshiya Nagasaki and Takashi Akiyoshi have contributed equally to this work.

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    Nagasaki, T., Akiyoshi, T., Fujimoto, Y. et al. Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases. World J Surg 41, 876–883 (2017). https://doi.org/10.1007/s00268-016-3748-y

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    • DOI: https://doi.org/10.1007/s00268-016-3748-y

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