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Predicting lateral pelvic lymph node metastasis based on magnetic resonance imaging before and after neoadjuvant chemotherapy for patients with locally advanced lower rectal cancer

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Abstract

Purpose

We examined the association between pathological lateral pelvic lymph node (LPLN) metastasis and the LPLN diameter in patients with locally advanced rectal cancer (LARC) who received a neoadjuvant chemotherapy (NAC) regimen based on oxaliplatin as induction chemotherapy. We aimed to determine whether or not the LPLN size predicts LPLN metastasis in NAC cases.

Methods

We retrospectively examined data from 3 institutes for 60 patients with LARC who received mesorectal excision and LPLN dissection after NAC. We evaluated the LPLN size on magnetic resonance imaging (MRI) scans acquired before and after NAC. We performed multivariate analyses to analyze the relationship between the LPLN size and clinicopathological factors.

Results

For patients with visible LPLNs, the median short-axis diameter (SA) was significantly reduced from 5.1 mm (range 2.0–17.4) before NAC to 3.7 mm (range 2.1–19.0) after NAC (p = 0.0479). SA diameters were significantly larger in pathological LPLNs than in healthy LPLNs, both before (p = 0.0002) and after NAC (p < 0.0001). A SA cut-off value of 7 mm before NAC was able to independently predict lymph node metastasis (p = 0.0178).

Conclusions

We showed that MRI-based evaluations of LPLN size were able to predict metastasis in patients who underwent NAC for LARC. This finding might be useful when considering selective LPLN dissection in NAC cases.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, E2, Suita, Osaka, 565-0871, Japan

    Yuki Sekido, Junichi Nishimura, Shiki Fujino, Takayuki Ogino, Norikatsu Miyoshi, Hidekazu Takahashi, Mamoru Uemura, Naotsugu Haraguchi, Taishi Hata, Chu Matsuda, Tsunekazu Mizushima & Yuichiro Doki

  2. Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan

    Junichi Nishimura

  3. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan

    Taishi Hata & Kohei Murata

  4. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan

    Junichi Hasegawa

  5. Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan

    Masaki Mori

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  1. Yuki Sekido
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  2. Junichi Nishimura
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  10. Chu Matsuda
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  15. Yuichiro Doki
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Correspondence to Junichi Nishimura.

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Sekido, Y., Nishimura, J., Fujino, S. et al. Predicting lateral pelvic lymph node metastasis based on magnetic resonance imaging before and after neoadjuvant chemotherapy for patients with locally advanced lower rectal cancer. Surg Today 50, 292–297 (2020). https://doi.org/10.1007/s00595-019-01886-7

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  • DOI: https://doi.org/10.1007/s00595-019-01886-7

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