Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis
We aimed to clarify the prognostic impact of lateral pelvic lymph node (LPN) dissection (LPND) for rectal cancer through a multicenter retrospective study using propensity score analysis.
A total of 1238 patients with pathological T2-4, M0 rectal cancer who had undergone curative operation between 2007 and 2008 were examined. Majority of the patients (96 %) were treated without preoperative chemoradiotherapy (CRT). Clinical background data of the patients treated with LPND and those treated without LPND were matched using propensity scores, and hazard ratios (HRs) for cancer-specific mortality were compared.
LPND was performed more frequently for lower rectal cancers and in patients with more advanced disease, and 29 % of the patients were treated with LPND. After matching background features by propensity scores, LPND did not correlate with improved cancer-specific survival (CSS) among the entire study population [HR, 0.73; 95 % confidence interval (CI) 0.41–1.31; P = 0.28]; however, LPND was correlated with significantly improved CSS in female patients (HR, 0.23; 95 % CI, 0.06–0.89; P = 0.04) but not in male patients (HR, 0.95; 95 % CI, 0.48–1.89; P = 0.89). The results were similar when patients treated with LPND finally diagnosed as pathologically negative for LPN metastasis were compared with those curatively treated without LPND.
It is suggested that the prognostic impact of LPND for rectal cancer treated without CRT might be different between sexes, and LPND should be considered for female rectal cancer patients although they are diagnosed as clinically negative for LPN metastasis.
KeywordsRectal cancer Lateral pelvic lymph node dissection Surgery Propensity score analysis
This study is based on the data from 19 hospitals which are members of the Japanese Society for Cancer of the Colon and Rectum: First Department of Surgery, Sapporo Medical University; Department of Surgery, Hirosaki University; Division of Digestive and General Surgery, Niigata University; Department of Surgery, National Defense Medical College; Department of Surgery, Tochigi Cancer Center; Department of Surgery, Kyorin University; Department of Surgery, Tokyo Metropolitan Komagome Hospital; Department of Surgery II, Tokyo Women’s Medical University; Department of Surgery, International Medical center of Japan; Department of Surgery, Keio University; Department of Surgery, Teikyo University; Department of Surgical Oncology, Tokyo Medical and Dental University; Colorectal Surgery Division, National Cancer Center Hospital; Department of Surgical Oncology, The University of Tokyo; Department of Surgery, Fujita Health University; Department of Gastroenterological Surgery, Aichi Cancer Center Research Institute; Department of Surgery, Kyoto University; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases; Department of Surgery, Kurume University; Department of Surgery, Hyogo College of Medicine
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20(2):207–239. doi: 10.1007/s10147-015-0801-z CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701. doi: 10.1097/01.sla.0000257358.56863.ce CrossRefPubMedGoogle Scholar
- 15.Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625. doi: 10.1200/JCO.2006.06.7629 CrossRefPubMedGoogle Scholar
- 20.Kim TG, Park W, Choi DH, Park HC, Kim SH, Cho YB, Yun SH, Kim HC, Lee WY, Lee J, Park JO, Park YS, Lim HY, Kang WK, Chun HK (2014) Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. Int J Colorectal Dis 29(2):193–200. doi: 10.1007/s00384-013-1797-3 CrossRefPubMedGoogle Scholar
- 21.Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, Chang HJ, Lim SB, Choi HS, Park JG (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15(3):729–737. doi: 10.1245/s10434-007-9696-x CrossRefPubMedGoogle Scholar
- 22.Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Unno T, Kano A, Kuroyanagi H, Oya M, Yamaguchi T, Watanabe T, Muto T (2014) Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol 21(1):189–196. doi: 10.1245/s10434-013-3216-y CrossRefPubMedGoogle Scholar
- 24.Ishihara S, Hayama T, Yamada H, Nozawa K, Matsuda K, Miyata H, Yoneyama S, Tanaka T, Tanaka J, Kiyomatsu T, Kawai K, Nozawa H, Kanazawa T, Kazama S, Yamaguchi H, Sunami E, Kitayama J, Hashiguchi Y, Sugihara K, Watanabe T (2014) Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: a propensity score analysis in a multicenter retrospective study. Ann Surg Oncol. doi: 10.1245/s10434-014-3719-1 Google Scholar
- 27.Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K (2012) 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 255(6):1129–1134. doi: 10.1097/SLA.0b013e3182565d9d CrossRefPubMedGoogle Scholar
- 28.Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, Ohue M, Fujii S, Shiozawa M, Yamaguchi T, Moriya Y (2012) Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 13(6):616–621. doi: 10.1016/s1470-2045(12)70158-4 CrossRefPubMedGoogle Scholar
- 30.Ishihara S, Hayama T, Yamada H, Nozawa K, Matsuda K, Miyata H, Yoneyama S, Tanaka T, Tanaka J, Kiyomatsu T, Kawai K, Nozawa H, Kanazawa T, Kazama S, Yamaguchi H, Sunami E, Kitayama J, Hashiguchi Y, Sugihara K, Watanabe T (2014) Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: a propensity score analysis in a multicenter retrospective study. Ann Surg Oncol 21(9):2949–2955. doi: 10.1245/s10434-014-3719-1 CrossRefPubMedGoogle Scholar
- 33.Mukai T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Ikeda A, Yamaguchi T (2013) Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer. Asian J Endosc Surg 6(4):314–317. doi: 10.1111/ases.12047 CrossRefPubMedGoogle Scholar
- 34.Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 23(25):6199–6206. doi: 10.1200/JCO.2005.14.779 CrossRefPubMedGoogle Scholar