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Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Soichiro Ishihara, Koji Murono, Kensuke Otani, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Junichiro Tanaka, Tomomichi Kiyomatsu, Kazushige Kawai, Keisuke Hata, Hioaki Nozawa, Shinsuke Kazama, Hironori Yamaguchi, Eiji Sunami & Toshiaki Watanabe

  2. Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan

    Yukihide Kanemitsu

  3. Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Kenichi Sugihara

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  1. Soichiro Ishihara
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Correspondence to Toshiaki Watanabe.

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The Study Group for Outcome Prediction after Colorectal Cancer Surgery of the Japanese Society for Cancer of the Colon and Rectum

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Ishihara, S., Kanemitsu, Y., Murono, K. et al. Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis. Int J Colorectal Dis 31, 1315–1321 (2016). https://doi.org/10.1007/s00384-016-2607-5

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