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The Significance of Lateral Lymph Node Metastasis in Low Rectal Cancer: a Propensity Score Matching Study

Journal of Gastrointestinal Surgery volume 25, pages 1866–1874 (2021)Cite this article

Abstract

Background

The indications for lateral lymph node dissection (LLND) in rectal cancer have been controversial. The purpose of this study was to clarify the significance of lateral lymph node metastasis in low rectal cancer.

Methods

This was a retrospective study at a high-volume cancer center in Japan. In this study, 40 patients with pathologically positive LLN (LLN+) were matched with 175 negative (LLN−) patients by propensity score matching (PSM). COX regression analysis was used to identify independent risk factors related to prognosis. The relapse-free survival rate (RFS) and overall survival rate (OS) of the 2 groups before and after matching were analyzed.

Results

Of the 64 patients undergoing LLND, 40 (62.5%) patients had LLN+ disease. The LLN+ patients showed deeper infiltration of the primary tumor than the LLN− patients (T3-T4: 87.5% vs. 72.0%; p = 0.044), a greater number of metastatic lymph nodes (N2: 75.0% vs. 35.4%; p < 0.001), and a higher rate of local recurrence (30% vs. 9.1%; p < 0.001). Adjuvant chemotherapy was more common in the 40 LLN+ patients than in the 175 LLN− patients (70.0% vs. 46.8%; p = 0.008). After relapse, the rate of first-line chemotherapy administration for LLN+ patients was higher than that for the LLN− patients (62.5% vs. 29.5%; p = 0.005). The RFS of LLN+ patients was shorter than that of the LLN− patients (p = 0.005). After PSM, although more LLN+ patients received adjuvant chemotherapy than the LLN− patients (70.0% vs. 40.0%; p = 0.007), the local recurrence rate remained higher (30% vs. 10%; p = 0.025). The differences between RFS (p = 0.655) and OS rates (p = 0.164) of the 2 patient groups were not significant.

Conclusion

Even after LLND, patients with LLN+ low rectal cancer still showed an elevated local recurrence rate. Controlling local recurrence by adjuvant chemotherapy alone is difficult, and the additional strategic treatments are needed.

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Acknowledgments

Our thanks are extended to BioMed Proofreading, LLC for English copyediting.

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Affiliations

  1. Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan

    Liming Wang, Yasumitsu Hirano, Gregory Heng, Toshimasa Ishii, Hiroka Kondo, Kiyoka Hara, Nao Obara, Masahiro Asari & Shigeki Yamaguchi

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  1. Liming Wang
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  2. Yasumitsu Hirano
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Contributions

LMW and YH drafted the manuscript. TI, HK, KH, NO, MA, GH, and SY reviewed its content. All authors have read and approved the final submission.

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Correspondence to Liming Wang.

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Wang, L., Hirano, Y., Heng, G. et al. The Significance of Lateral Lymph Node Metastasis in Low Rectal Cancer: a Propensity Score Matching Study. J Gastrointest Surg 25, 1866–1874 (2021). https://doi.org/10.1007/s11605-020-04825-x

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  • DOI: https://doi.org/10.1007/s11605-020-04825-x

Keywords

  • Lateral lymph node dissection
  • Low rectal cancer
  • Propensity score matching