Skip to main content

Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy

International Journal of Colorectal Disease volume 28, pages 1667–1674 (2013)Cite this article

Abstract

Purpose

To identify the indication and prognostic significance of lateral lymph node (LLN) excision in locally advanced rectal cancer patients underwent preoperative chemoradiotherapy.

Methods

Included were 67 consecutive patients with suspicious LLN metastasis who underwent chemoradiotherapy and surgery including selective LLN excision (82 excisions). The excisions were grouped according to the presence of LLN metastasis and compared in terms of the clinicopathological findings and oncological results. The correlation between the largest short-axis diameter of LLN measured by imaging and metastasis rates was explored.

Results

LLN metastases were identified in 32 excisions (40.0 %). The calculated short-axis LLN diameter predicting metastasis was 11.7 mm (before chemoradiotherapy) and 11.4 mm (before surgery). LLN metastasis was observed more frequently in the low rectum (p = 0.031) and associated with higher CEA levels (p = 0.048). The 3-year overall survival rates for patients with and without LLN metastasis were 60.3 % and 90.3 % (p = 0.048), while the 3-year disease-free survival rates were 31.4 % and 70.5 % (p = 0.009). The hazard ratio of LLN metastasis for recurrence was 2.938 (95 % CI = 1.258–6.863).

Conclusions

LLN metastasis in rectal cancer patients underwent chemoradiotherapy was a distinct poor prognostic factor. Selective LLN excision based on imaging studies may have a role for such patients.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Engstrom PF, Arnoletti JP, Benson AB 3rd et al. (2012) The NCCN clinical practice guidelines in oncology, version 4.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.

  2. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    PubMed  Article  CAS  Google Scholar 

  3. Garcia-Aguilar J, Cromwell JW, Marra C et al (2001) Treatment of locally recurrent rectal cancer. Dis Colon Rectum 44:1743–1748

    PubMed  Article  CAS  Google Scholar 

  4. Das P, Skibber JM, Rodriguez-Bigas MA et al (2006) Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 29:219–224

    PubMed  Article  Google Scholar 

  5. Hida J, Yasutomi M, Fujimoto K et al (1997) Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg 184:475–480

    PubMed  CAS  Google Scholar 

  6. Takahashi T, Ueno M, Azekura K et al (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43(suppl 10):S59–S68

    PubMed  Article  CAS  Google Scholar 

  7. Ueno H, Mochizuki H, Hashiguchi Y et al (2001) Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 234:190–197

    PubMed  Article  CAS  Google Scholar 

  8. Kim TH, Jeong SY, Choi DH et al (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 15:729–737

    PubMed  Article  Google Scholar 

  9. Moriya Y, Sugihara K, Akasu T et al (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21:728–732

    PubMed  Article  CAS  Google Scholar 

  10. Enker WE, Thaler HT, Cranor ML et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346

    PubMed  CAS  Google Scholar 

  11. Kusters M, Beets GL, van de Velde CJ et al (2009) A comparison between the treatment of low rectal cancer in Japan and The Netherlands, focusing on the patterns of local recurrence. Ann Surg 249:229–235

    PubMed  Article  Google Scholar 

  12. Kim JC, Takahashi K, Yu CS et al (2007) Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 246:754–762

    PubMed  Article  Google Scholar 

  13. Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354

    PubMed  Article  CAS  Google Scholar 

  14. Kim JH, Beets GL, Kim MJ et al (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83

    PubMed  Article  Google Scholar 

  15. Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23

    PubMed  Article  CAS  Google Scholar 

  16. Youden WJ (1950) Index for rating diagnostic test. Cancer 3:32–35

    PubMed  Article  CAS  Google Scholar 

  17. Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672

    PubMed  Article  Google Scholar 

  18. Sugihara K, Moriya Y, Akasu T et al (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880

    PubMed  Article  CAS  Google Scholar 

  19. Kusters M, Wallner C, Lange MM et al (2010) Origin of presacral local recurrence after rectal cancer treatment. Br J Surg 97:1582–1587

    PubMed  Article  CAS  Google Scholar 

  20. Konishi T, Watanabe T, Nagawa H et al (2010) Preoperative chemoradiation and extended pelvic lymphadenectomy for rectal cancer: two distinct principles. World J Gastrointest Surg 27:95–100

    Article  Google Scholar 

  21. Nagawa H, Muto T, Sunouchi K et al (2001) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44:1274–1280

    PubMed  Article  CAS  Google Scholar 

  22. Williams AD, Cousins C, Soutter WP et al (2001) Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography. AJR Am J Roentgenol 177:343–348

    PubMed  Article  CAS  Google Scholar 

  23. Matsuoka H, Nakamura A, Masaki T et al (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27:3529–3534

    PubMed  Google Scholar 

  24. Georgiou P, Tan E, Gouvas N et al (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053–1062

    PubMed  Article  Google Scholar 

  25. Yano H, Moran BJ, Watanabe T et al (2010) Lateral pelvic lymph-node dissection: still an option for cure. Lancet Oncol 11:114

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors declare no conflicts of interest.

Author information

Affiliations

  1. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Republic of Korea

    Seok-Byung Lim, Chang Sik Yu, Chan Wook Kim, Yong Sik Yoon & Jin Cheon Kim

  2. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Seong Ho Park

  3. Department of Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Tae Won Kim

  4. Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Jong Hoon Kim

Authors
  1. Seok-Byung Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Sik Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chan Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Sik Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seong Ho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tae Won Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jong Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jin Cheon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seok-Byung Lim.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lim, SB., Yu, C.S., Kim, C.W. et al. Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Int J Colorectal Dis 28, 1667–1674 (2013). https://doi.org/10.1007/s00384-013-1761-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1761-2

Keywords

  • Preoperative chemoradiotherapy
  • Rectal adenocarcinoma
  • Lateral lymph node