Journal of Gastrointestinal Surgery

, Volume 23, Issue 7, pp 1454–1460 | Cite as

Oncological Outcomes of Patients with Locally Advanced Rectal Cancer and Lateral Pelvic Lymph Node Involvement

  • Ipek Sapci
  • Conor P. Delaney
  • David Liska
  • Sudha Amarnath
  • Matthew F. Kalady
  • Scott R. Steele
  • Emre GorgunEmail author
2018 SSAT Plenary Presentation



The optimal management of patients with radiologically positive lateral pelvic lymph nodes in locally advanced rectal cancer remains unclear. We compared local recurrence rates and oncological outcomes of patients with locally advanced cancer with and without lateral pelvic lymph nodes.


Patients who underwent curative surgery for stage III rectal adenocarcinoma between 2009 and 2014 and had a preoperative MRI at our institution as well as preoperative neoadjuvant treatment were included. Patients with positive lateral pelvic lymph nodes (iliac or obturator nodes) on preoperative MRI (LPND +) were compared to patients with no lateral pelvic nodal disease (LPND −). Data were collected from a prospectively maintained institutional database. Differences between the groups were compared in univariate analysis. Log-rank test was used to evaluate overall and disease-free survival between the groups.


A total of 125 patients met inclusion criteria with a mean age of 56.3 ± 12.2 and 75% were male. Median follow-up was 44 months (IQR 32, 106). Positive LPND was present on preoperative MRI in 43/125 (34.4%) patients who were in the LPND (+) group. Seventeen out of 43 patients had a post-neoadjuvant treatment MRI and 15 patients had a decrease in size of nodes or disappearance of LPND. On univariate analysis, LPND (+) and LPND (−) groups were comparable. Local recurrence rates were higher in the LPND (+) group, although this was not statistically significant (16.3% vs. 6%, p = 0.06). Overall and disease-free survival rates were comparable between the LPND (+) and LPND (−) groups (p = 0.97, p = 0.51).


Management of patients with advanced rectal cancer and radiologically positive lateral pelvic lymph nodes is challenging due to high local recurrence rates. Further studies are needed to develop care pathways for the optimal treatment processes.


Locally advanced rectal cancer Lateral pelvic lymph node Lymph node dissection Chemoradiation 


Authors’ Contributions

Ipek Sapci: Design of the work; acquisition, analysis, and interpretation of data; drafting and revising the work; final approval of the version to be published.

Conor P. Delaney: Design of the work, analysis and interpretation of data, revising the work, final approval of the version to be published.

David Liska: Design of the work, interpretation of data, revising the work, final approval of the version to be published.

Sudha Amarnath: Design of the work, interpretation of data, revising the work, final approval of the version to be published.

Matthew F. Kalady: Design of the work, interpretation of data, revising the work, final approval of the version to be published.

Scott R. Steele: Design of the work, interpretation of data, final approval of the version to be published.

Emre Gorgun: Conception and design of the work, analysis and interpretation of data, drafting and revising the work, final approval of the version to be published.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


All authors agree to be accountable for all aspects of the work.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Ipek Sapci
    • 1
  • Conor P. Delaney
    • 1
  • David Liska
    • 1
  • Sudha Amarnath
    • 2
  • Matthew F. Kalady
    • 1
  • Scott R. Steele
    • 1
  • Emre Gorgun
    • 1
    Email author
  1. 1.Department of Colorectal Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandUSA

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