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Feasibility and safety of lateral pelvic lymph node dissection for elderly patients with middle-low rectal cancer: results of a large multicenter lateral node collaborative group study in China

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Abstract

Background

Lateral pelvic lymph node (LPN) dissection can improve local control in certain rectal cancer patients with LPN metastasis. However, the effects of this technically complex procedure on perioperative safety and long-term survival of elderly patients (≥ 70 years) remain unclear.

Methods

Locally advanced middle–low rectal cancer patients diagnosed with LPN metastasis who underwent total mesorectal excision (TME) with LPN dissection at three institutions from January 2012 to December 2019 were included in this study. Additionally patients who had neoadjuvant chemoradiotherapy (nCRT) and those who did not were compared.

Results

In total there were 407 patients, including 49 elderly and 358 non-elderly patients, of which 249 were male, with a median age of 58 years (range:18–85 years). In the whole cohort, operation time (280.7 vs. 292.0 min, p = 0.498) and estimated blood loss (100 vs. 100 ml, p = 0.384) were comparable in the elderly and non-elderly groups. There was no significant difference in the incidences of overall complications (24.5% vs. 19.8%, p = 0.448) and severe (Clavien–Dindo grade 3–5) surgical complications (8.2% vs. 7.5%, p = 0.778) between the two groups. However, the incidence of urinary retention (14.3% vs. 5.6%, p = 0.032) and intensive care unit admission (16.3% vs. 6.1%, p = 0.018) was significantly higher in the elderly group compared with those in the non-elderly group. The 3-year overall survival (88.7% vs. 82.1%, p = 0.516) and disease-free survival (81.2% vs. 70.7%, p = 0.352) were comparable between the two groups. Moreover, results in the nCRT cohort were comparable to those in the overall cohort.

Conclusions

Even with nCRT, TME combined with LPN dissection is safe and feasible for elderly patients, demonstrating low mortality and acceptable morbidity. Elderly and non-elderly patients with LPN metastasis who undergo LPN dissection can achieve comparable 3-year survival outcomes.

Trail Registration

ClinicalTrials.gov Identifier: NCT04850027.

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Data availability

Data can be provided upon reasonable request by email directly sent to the corresponding author.

References

  1. Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease?: Is it regional or distant disease? Ann Surg 255(6):1129–1134. https://doi.org/10.1097/SLA.0b013e3182565d9d

    Article  PubMed  Google Scholar 

  2. Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49(11):1663–1672. https://doi.org/10.1007/s10350-006-0714-z

    Article  PubMed  Google Scholar 

  3. Yano H, Moran BJ (2008) The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg 95(1):33–49. https://doi.org/10.1002/bjs.6061

    Article  CAS  PubMed  Google Scholar 

  4. Bosset JF, Calais G, Mineur L et al (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15(2):184–190. https://doi.org/10.1016/S1470-2045(13)70599-0

    Article  CAS  PubMed  Google Scholar 

  5. Fujita S, Mizusawa J, Kanemitsu Y et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 266(2):201–207. https://doi.org/10.1097/SLA.0000000000002212

    Article  PubMed  Google Scholar 

  6. Hajibandeh S, Hajibandeh S, Matthews J et al (2020) Meta-analysis of survival and functional outcomes after total mesorectal excision with or without lateral pelvic lymph node dissection in rectal cancer surgery. Surgery 168(3):486–496. https://doi.org/10.1016/j.surg.2020.04.063

    Article  PubMed  Google Scholar 

  7. Jones HG, Radwan RW, Sams E et al (2020) Incidence and treatment of positive pelvic sidewall lymph nodes in patients with rectal cancer. Colorectal Dis 22(11):1560–1567. https://doi.org/10.1111/codi.15176

    Article  CAS  PubMed  Google Scholar 

  8. Malakorn S, Yang Y, Bednarski BK et al (2019) Who should get lateral pelvic lymph node dissection after neoadjuvant chemoradiation? Dis Colon Rectum 62(10):1158–1166. https://doi.org/10.1097/DCR.0000000000001465

    Article  PubMed  Google Scholar 

  9. Yang X, Gu C, Hu T et al (2021) Indications and oncological outcomes of selective dissection for clinically suspected lateral lymph node metastasis in patients with rectal cancer based on pretreatment imaging. Tech Coloproctol 25(4):425–437. https://doi.org/10.1007/s10151-020-02386-4

    Article  PubMed  Google Scholar 

  10. Kawai K, Shiratori H, Hata K et al (2021) Optimal size criteria for lateral lymph node dissection after neoadjuvant chemoradiotherapy for rectal cancer. Dis Colon Rectum 64(3):274–283. https://doi.org/10.1097/DCR.0000000000001866

    Article  PubMed  Google Scholar 

  11. Heriot AG, Tekkis PP, Smith JJ et al (2006) Prediction of post-operative mortality in elderly patients with colorectal cancer. Dis Colon Rectum 49(6):816–824. https://doi.org/10.1007/s10350-006-0523-4

    Article  PubMed  Google Scholar 

  12. Etzioni DA, Beart RW Jr, Madoff RD et al (2009) Impact of the aging population on the demand for colorectal procedures. Dis Colon Rectum. 52(4):583–90. https://doi.org/10.1007/DCR.0b013e3181a1d183. (discussion 590-1)

    Article  PubMed  Google Scholar 

  13. van Eeghen EE, den Boer FC, Loffeld RJ (2015) Thirty days post-operative mortality after surgery for colorectal cancer: a descriptive study. J Gastrointest Oncol 6(6):613–617. https://doi.org/10.3978/j.issn.2078-6891.2015.079

    Article  PubMed  PubMed Central  Google Scholar 

  14. Arnarson Ö, Butt-Tuna S, Syk I (2019) Post-operative complications following colonic resection for cancer are associated with impaired long-term survival. Colorectal Dis 21(7):805–815. https://doi.org/10.1111/codi.14613

    Article  CAS  PubMed  Google Scholar 

  15. Amin MB, Greene FL, Edge SB, et al (2017) The Eighth Edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67(2):93–99

  16. Wang P, Zhou S, Zhou H et al (2019) Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy. Colorectal Dis 21(7):791–796. https://doi.org/10.1111/codi.14595

    Article  CAS  PubMed  Google Scholar 

  17. Zhou S, Jiang Y, Pei W et al (2021) Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: a retrospective study of its safety and indications. J Surg Oncol 124(3):354–360. https://doi.org/10.1002/jso.26509

    Article  PubMed  Google Scholar 

  18. Hashiguchi Y, Muro K, Saito Y et al (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25(1):1–42. https://doi.org/10.1007/s10147-019-01485-z

    Article  PubMed  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  20. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  21. Duong TT, An HH, Quoc LV et al (2021) Laparoscopic lateral pelvic lymph node dissection for advanced lower rectal cancer: a preliminary vietnamese study. Med Arch 75(4):297–301. https://doi.org/10.5455/medarh.2021.75.297-301

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhou S, Tang J, Mei S et al (2022) Risk factors and prognostic significance of postoperative complications following lateral pelvic lymph node dissection for rectal cancer: results of the multicenter lateral node study in China. Jpn J Clin Oncol 52(10):1150–1158. https://doi.org/10.1093/jjco/hyac109

    Article  PubMed  Google Scholar 

  23. Saito S, Fujita S, Mizusawa J et al (2016) Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 42(12):1851–1858. https://doi.org/10.1016/j.ejso.2016.07.010

    Article  CAS  PubMed  Google Scholar 

  24. Jiang Y, Zhou S, Pei W et al (2022) Does neoadjuvant chemoradiotherapy increase the effect of lateral lymph node dissection on urogenital function? Transl Cancer Res 11(4):784–795. https://doi.org/10.21037/tcr-22-87

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank TopEdit (www.topeditsci.com) for its linguistic assistance during the preparation of this manuscript. The authors thank all members and staff of the Chinese Lateral Node Collaborative Group for collecting data.

Funding

This study received funding from the National Key Research and Development Program/Prevent and Control Research for Important Non-Communicable Diseases (No. 2019YFC1315705) and the Medicine and Health Technology Innovation Project of the Chinese Academy of Medical Sciences (No. 2017-12M-1e006).

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Author notes

  1. S. Zhou and S. Mei contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Sicheng Zhou, Shiwen Mei & Qian Liu

  2. Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, China

    Bo Feng

  3. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China

    Yingchi Yang

  4. Department of General Surgery, Peking University First Hospital, Beijing, China

    Xin Wang

  5. Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 1 Xinmin Dajie, Chaoyang District, Changchun, 130012, China

    Quan Wang

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Contributions

All authors made a significant contribution to this study in either some or all of the aspects, including the study conception, design, execution, data acquisition, analysis and interpretation, and manuscript drafting, revising, or reviewing. All authors gave final approval for the version to be published, have agreed on the journal to which the article has been submitted, and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Quan Wang or Qian Liu.

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Conflicts of interest

Sicheng Zhou, Shiwen Mei, Bo Feng, Yingchi Yang, Xin Wang, Quan Wang, and Qian Liu have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was performed with approval by the Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (NCC 2017-YZ-026, Oct 17, 2017).

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Prior written informed consent was obtained from all study participants.

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Zhou, S., Mei, S., Feng, B. et al. Feasibility and safety of lateral pelvic lymph node dissection for elderly patients with middle-low rectal cancer: results of a large multicenter lateral node collaborative group study in China. Tech Coloproctol 27, 655–664 (2023). https://doi.org/10.1007/s10151-022-02746-2

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