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Preoperative factors associated with lateral lymph node metastasis in lower rectal cancer and the evaluation of the middle rectal artery

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Abstract

Purpose

This study aimed to identify cases in which lateral lymph node (LLN) dissection (LLND) can be excluded by clarifying preoperative factors, including an evaluation of the middle rectal artery (MRA), associated with LLN metastasis.

Methods

Fifty-five consecutive patients who underwent preoperative positron emission tomography–computed tomography (PET/CT) and total mesorectal excision with LLND for rectal cancer were included. We retrospectively investigated the preoperative clinical factors associated with pathological LLN (pLLN) metastasis. We analyzed the regions of pLLN metastasis using MRA.

Results

pLLN metastasis occurred in 13 (23.6%) patients. According to a multivariate analysis, clinical LLN (cLLN) metastasis based on short-axis size and LLN status based on PET/CT were independent preoperative factors of pLLN metastasis. The negative predictive value (NPV) was high (97.1%) in patients evaluated as negative based on PET/CT and cLLN short-axis size. MRA was detected in 24 patients (43.6%) using contrast-enhanced CT, and there was a significant relationship between pLLN metastasis and the presence of MRA. pLLN metastasis in the internal iliac region but not in the obturator region was significantly correlated with the presence of MRA.

Conclusion

Combined cLLN metastasis based on short-axis size and PET/CT showed a higher NPV, suggesting this to be a useful method for identifying cases in which LLND can be excluded.

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Funding

The authors have not received financial support from any funding sources for this study.

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Authors and Affiliations

  1. Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Takuya Shiraishi, Hiroomi Ogawa, Arisa Yamaguchi, Yuta Shibasaki, Katsuya Osone, Takuhisa Okada, Makoto Sakai, Makoto Sohda, Ken Shirabe & Hiroshi Saeki

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  1. Takuya Shiraishi
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  2. Hiroomi Ogawa
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Correspondence to Makoto Sohda.

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Shiraishi, T., Ogawa, H., Yamaguchi, A. et al. Preoperative factors associated with lateral lymph node metastasis in lower rectal cancer and the evaluation of the middle rectal artery. Surg Today (2024). https://doi.org/10.1007/s00595-024-02868-0

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