Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study
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Although lateral pelvic node dissection (LPND) is recommended for rectal cancer with clinically metastatic lateral pelvic lymph nodes (LPNs), LPNs may respond to neoadjuvant chemoradiotherapy (nCRT). Our aim was to determine the optimal indication for LPND after nCRT for mid/low rectal cancer.
Of 2,263 patients with clinical stage II/III mid/low rectal cancer who were managed at three tertiary referral hospitals, 66 patients underwent curative surgery including LPND after nCRT were included in this study. Risk factors for LPN metastasis were retrospectively analyzed and oncologic outcomes determined according to LPN response to nCRT.
Persistent LPNs greater than 5 mm on post-nCRT magnetic resonance imaging were significantly associated with residual tumor metastasis, unlike responsive LPN after nCRT (short-axis diameter ≤5 mm) (pathologically, 61.1 % [22 of 36] vs. 0 % [0 of 30], P < 0.001). Multivariable analysis revealed post-nCRT LPN size as a significant and independent risk factor for LPN metastasis (odds ratio 2.390; 95 % confidence interval 1.104–4.069). Over a median follow-up of 39.3 months, the recurrence rate was lower in patients with responsive nodes than in patients with persistent nodes (20 % [6 of 30] vs. 47.2 % [17 of 36], P = 0.012). The 5-year overall survival and 5-year disease-free survival rates were lower in patients with persistent LPN than in patients with responsive LPN (44.6 % vs. 77.1 %, P = 0.034; 33.7 % vs. 72.5 %, P = 0.011, respectively).
In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.
KeywordsRectal Cancer Total Mesorectal Excision Lateral Node Systemic Recurrence Urinary Dysfunction
Support for statistical analysis was provided by the Medical Research Collaborating Center, Seoul National University Bundang Hospital, Korea.
The authors declare no conflict of interest.
- 5.Benson A III, Bekaii-Saab T, Chan E. NCCN clinical practice guidelines in oncology: rectal cancer. Version 4. 2013. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
- 8.Fujita S, Akasu T, Mizusawa J, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13:616–21.PubMedCrossRefGoogle Scholar
- 12.Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–7.Google Scholar
- 25.Edge SB, Byrd DR, Compton CC, Fritz AG. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. Google Scholar