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The total number of lymph node metastases is a more significant risk factor for poor prognosis than positive lateral lymph node metastasis

Surgery Today volume 45, pages 168–174 (2015)Cite this article

Abstract

Purpose

Lateral lymph nodes (LLNs) along the iliac vessels are an important indicator of local recurrence; however, we are unaware of any study that investigates whether the number of LLN metastases influences the prognosis of patients with lower rectal cancer.

Method

We analyzed retrospectively the records of 154 patients who underwent radical resection of T1–4 lower rectal adenocarcinoma at a single institution.

Results

Among the 88.3 % of patients who underwent LLN dissection, 13 (8.4 %) had LLN metastasis. The Cox proportional hazard model indicated that sex, histological grade, lymphatic or venous invasion, and LLN metastasis were not significantly associated with tumor recurrence, whereas tumor depth and more than three lymph node metastases were risk factors for recurrence (p = 0.002 and p = 0.02, respectively). Of the 13 patients with LLN metastasis, 6 whose mesenteric lymph nodes (MLNs) had been well dissected and examined did not have MLN metastasis.

Conclusions

The presence of one or two LLN metastases in patients who have undergone LLN dissection with surgery for lower rectal cancer is not associated with poor prognosis. The number of LLN metastases is a more significant risk factor for poor prognosis.

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Acknowledgments

We thank Dr. Hiroshi Toda of the Toda Clinic, former SHGH co-director, for assisting us in establishing our surgical procedures, and Dr. Shigeo Tobayama, current SHGH co-director, for his encouragement throughout this study.

Conflict of interest

Yoichiro Homma and his co-authors have no conflicts of interest.

Author information

Affiliations

  1. Department of Colorectal Surgery, Seirei Hamamatsu General Hospital, Naka-ku Sumiyoshi 2-12-12, Hamamatsu, Shizuoka, 430-8558, Japan

    Yoichiro Homma, Takashi Hamano & Yasuyuki Kobayashi

  2. Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan

    Yoshiro Otsuki & Shinichi Shimizu

Authors
  1. Yoichiro Homma
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  2. Takashi Hamano
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  3. Yoshiro Otsuki
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  4. Shinichi Shimizu
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  5. Yasuyuki Kobayashi
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Corresponding author

Correspondence to Yoichiro Homma.

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Homma, Y., Hamano, T., Otsuki, Y. et al. The total number of lymph node metastases is a more significant risk factor for poor prognosis than positive lateral lymph node metastasis. Surg Today 45, 168–174 (2015). https://doi.org/10.1007/s00595-014-0913-5

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  • DOI: https://doi.org/10.1007/s00595-014-0913-5

Keywords

  • Lower rectal cancer
  • Lateral lymph nodes
  • Regional lymph nodes