Risk factors and prognostic significance of lateral pelvic lymph node metastasis in advanced rectal cancer

  • Yukiharu Hiyoshi
  • Yuji Miyamoto
  • Yuki Kiyozumi
  • Kojiro Eto
  • Yohei Nagai
  • Masaaki Iwatsuki
  • Shiro Iwagami
  • Yoshifumi Baba
  • Naoya Yoshida
  • Hideo BabaEmail author
Original Article



The aim of this study was to elucidate the risk factors for and prognostic value of lateral pelvic lymph node (LPLN) metastasis in advanced rectal cancer patients, including those with stage IV disease.


The treatment outcomes of 78 patients with advanced rectal cancer, the lower margin of which was located at or below the peritoneal reflection, who underwent curative-intent surgery with bilateral LPLN dissection from 2005 to 2018 were retrospectively analyzed.


In total, 78 rectal cancer patients, including 13 patients with stage IV tumors, 9 patients (11.5%) had LPLN metastasis. A multivariate analysis to identify preoperative clinical factors associated with LPLN metastasis showed that tumor location (below the peritoneal reflection: Rb), LPLN metastasis on preoperative imaging and distant metastasis were independent predictors of LPLN metastasis. In addition, metastasis at the regional lymph nodes in the mesorectum was significantly associated with LPLN metastasis. Both the disease-free survival (DFS) and cancer-specific survival (CSS) of patients with LPLN metastasis were significantly worse in comparison to patients without LPLN metastasis, and the CSS of stage IV patients with LPLN metastasis was significantly worse in comparison to stage IV patients without LPLN metastasis.


Tumor location (Rb), LPLN metastasis on preoperative imaging and distant metastasis were risk factors for LPLN metastasis. The prognosis of rectal cancer patients with LPLN metastasis is poor. There may not be the indication of LPLN dissection in stage IV lower rectal cancer except cases having complaints due to LPLN metastasis.


Rectal cancer Lateral pelvic lymph node Metastasis Prognosis 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Heald RJ (1988) The 'Holy Plane' of rectal surgery. J R Soc Med 81:503–508CrossRefGoogle Scholar
  2. 2.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefGoogle Scholar
  3. 3.
    Bruheim K, Guren MG, Skovlund E et al (2010) Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 76:1005–1011CrossRefGoogle Scholar
  4. 4.
    Rothenberger DA, Akbari R, Baxter NN (2004) Are we overtreating some patients with rectal cancer? Oncology 18:1789–1796Google Scholar
  5. 5.
    Watanabe T, Muro K, Ajioka Y et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23:1–34CrossRefGoogle Scholar
  6. 6.
    Fujita S, Yamamoto S, Akasu T et al (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585CrossRefGoogle Scholar
  7. 7.
    Ueno M, Oya M, Azekura K et al (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763CrossRefGoogle Scholar
  8. 8.
    Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672CrossRefGoogle Scholar
  9. 9.
    Fujita S, Mizusawa J, Kanemitsu Y et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 266:201–207CrossRefGoogle Scholar
  10. 10.
    Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32:128–133CrossRefGoogle Scholar
  11. 11.
    Fujita S, Yamamoto S, Akasu T et al (2009) Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis 24:1085–1090CrossRefGoogle Scholar
  12. 12.
    Miyake Y, Mizushima T, Hata T et al (2017) Inspection of perirectal lymph nodes by one-step nucleic acid amplification predicts lateral lymph node metastasis in advanced rectal cancer. Ann Surg Oncol 24:3850–3856CrossRefGoogle Scholar
  13. 13.
    Yano H, Saito Y, Takeshita E et al (2007) Prediction of lateral pelvic node involvement in low rectal cancer by conventional computed tomography. Br J Surg 94:1014–1019CrossRefGoogle Scholar
  14. 14.
    Douillard JY, Oliner KS, Siena S et al (2013) Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 369:1023–1034CrossRefGoogle Scholar
  15. 15.
    Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342CrossRefGoogle Scholar
  16. 16.
    Saltz LB, Clarke S, Diaz-Rubio E et al (2008) Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 26:2013–2019CrossRefGoogle Scholar
  17. 17.
    Van Cutsem E, Kohne CH, Lang I et al (2011) Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol 29:2011–2019CrossRefGoogle Scholar
  18. 18.
    Van Cutsem E, Tabernero J, Lakomy R et al (2012) Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol 30:3499–3506CrossRefGoogle Scholar
  19. 19.
    Grothey A, Van Cutsem E, Sobrero A et al (2013) Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 381:303–312CrossRefGoogle Scholar
  20. 20.
    Mayer RJ, Van Cutsem E, Falcone A et al (2015) Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med 372:1909–1919CrossRefGoogle Scholar
  21. 21.
    Adam R, Wicherts DA, de Haas RJ et al (2009) Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol 27:1829–1835CrossRefGoogle Scholar
  22. 22.
    Tomlinson JS, Jarnagin WR, DeMatteo RP et al (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580CrossRefGoogle Scholar
  23. 23.
    Hasegawa J, Nishimura J, Mizushima T et al (2014) Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer. Cancer Chemother Pharmacol 73:1079–1087CrossRefGoogle Scholar
  24. 24.
    Hasegawa S, Goto S, Matsumoto T et al (2017) A multicenter phase 2 study on the feasibility and efficacy of neoadjuvant chemotherapy without radiotherapy for locally advanced rectal cancer. Ann Surg Oncol 24:3587–3595CrossRefGoogle Scholar
  25. 25.
    Schrag D, Weiser MR, Goodman KA et al (2014) Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 32:513–518CrossRefGoogle Scholar
  26. 26.
    Uehara K, Hiramatsu K, Maeda A et al (2013) Neoadjuvant oxaliplatin and capecitabine and bevacizumab without radiotherapy for poor-risk rectal cancer: N-SOG 03 phase II trial. Jpn J Clin Oncol 43:964–971CrossRefGoogle Scholar
  27. 27.
    Furuhata T, Okita K, Nishidate T et al (2015) Clinical feasibility of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced rectal cancer. Surg Today 45:310–314CrossRefGoogle Scholar
  28. 28.
    Liang JT (2011) Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg Oncol 18:153–159CrossRefGoogle Scholar
  29. 29.
    Nagayoshi K, Ueki T, Manabe T et al (2016) Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach. Surg Endosc 30:1938–1947CrossRefGoogle Scholar
  30. 30.
    Ogura A, Akiyoshi T, Nagasaki T et al (2017) Feasibility of laparoscopic total mesorectal excision with extended lateral pelvic lymph node dissection for advanced lower rectal cancer after preoperative chemoradiotherapy. World J Surg 41:868–875CrossRefGoogle Scholar
  31. 31.
    Matsuoka H, Nakamura A, Masaki T et al (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27:3529–3533Google Scholar
  32. 32.
    Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245:80–87CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Yukiharu Hiyoshi
    • 1
  • Yuji Miyamoto
    • 1
  • Yuki Kiyozumi
    • 1
  • Kojiro Eto
    • 1
  • Yohei Nagai
    • 1
  • Masaaki Iwatsuki
    • 1
  • Shiro Iwagami
    • 1
  • Yoshifumi Baba
    • 1
  • Naoya Yoshida
    • 1
  • Hideo Baba
    • 1
    Email author
  1. 1.Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan

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