Advertisement

Annals of Surgical Oncology

, Volume 21, Issue 7, pp 2280–2287 | Cite as

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

  • Heung-Kwon Oh
  • Sung-Bum KangEmail author
  • Sung-Min Lee
  • Soo Young Lee
  • Myoung Hun Ihn
  • Duck-Woo Kim
  • Ji Hoon Park
  • Young Hoon Kim
  • Kyung Ho Lee
  • Jae-Sung Kim
  • Jin Won Kim
  • Jee Hyun Kim
  • Tae-Young Chang
  • Sung-Chan Park
  • Dae Kyung Sohn
  • Jae Hwan Oh
  • Ji Won Park
  • Seung-Bum Ryoo
  • Seung-Yong Jeong
  • Kyu Joo Park
Colorectal Cancer

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.

Keywords

Rectal Cancer Total Mesorectal Excision Lateral Node Systemic Recurrence Urinary Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Support for statistical analysis was provided by the Medical Research Collaborating Center, Seoul National University Bundang Hospital, Korea.

Disclosure

The authors declare no conflict of interest.

References

  1. 1.
    Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Georgiou P, Tan E, Gouvas N, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10:1053–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Heriot AG, Byrne CM, Lee P, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum. 2008;51:284–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013;56:535–50.PubMedCrossRefGoogle Scholar
  5. 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.
  6. 6.
    Shihab OC, Taylor F, Bees N, et al. Relevance of magnetic resonance imaging–detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98:1798–804.PubMedCrossRefGoogle Scholar
  7. 7.
    Nagawa H, Muto T, Sunouchi K, et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum. 2001;44:1274–80.PubMedCrossRefGoogle Scholar
  8. 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
  9. 9.
    Koch M, Kienle P, Antolovic D, Buchler MW, Weitz J. Is the lateral lymph node compartment relevant? Recent Results Cancer Res. 2005;165:40–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Wang Z, Loh KY, Tan KY, Woo EC. The role of lateral lymph node dissection in the management of lower rectal cancer. Langenbecks Arch Surg. 2012;397:353–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Kim TH, Jeong SY, Choi DH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008;15:729–37.PubMedCrossRefGoogle Scholar
  12. 12.
    Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–7.Google Scholar
  13. 13.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRefGoogle Scholar
  14. 14.
    van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Watanabe T, Tsurita G, Muto T, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Kusters M, Beets GL, van de Velde CJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249:229–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11:637–45.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim YH, Kim DY, Kim TH, et al. Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:761–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim SH, Lee JY, Lee JM, Han JK, Choi BI. Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol. 2011;21:987–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Kim MJ, Kim KG, Lee JH, et al. Analysis of the anatomical characteristics of the pelvis in Koreans to aid in development of a NOTES platform. Surg Innov. 2013;20:134–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Ueno H, Mochizuki H, Hashiguchi Y, et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007;245:80–7.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Matsuoka H, Nakamura A, Masaki T, et al. Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res. 2007;27(5B):3529–33.PubMedGoogle Scholar
  23. 23.
    Moriya Y, Sugihara K, Akasu T, Fujita S. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg. 1997;21:728–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Kyo K, Sameshima S, Takahashi M, Furugori T, Sawada T. Impact of autonomic nerve preservation and lateral node dissection on male urogenital function after total mesorectal excision for lower rectal cancer. World J Surg. 2006;30:1014–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Edge SB, Byrd DR, Compton CC, Fritz AG. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. Google Scholar
  26. 26.
    Liang JT. Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg Oncol. 2011;18:153–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Park JS, Choi GS, Lim KH, et al. Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience. Surg Endosc. 2011;25:3322–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Beaumont C, Pandey T, Gaines Fricke R, Laryea J, Jambhekar K. (2013) MR evaluation of rectal cancer: current concepts. Curr Probl Diagn Radiol. 2013;42:99–112.CrossRefGoogle Scholar
  29. 29.
    Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Min BS, Kim JS, Kim NK, et al. Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis. Ann Surg Oncol. 2009;16:3271–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Beets-Tan RG, Lambregts DM, Maas M, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2013;23:2522–31.PubMedCrossRefGoogle Scholar
  32. 32.
    Koda K, Saito N, Oda K, Takiguchi N, Sarashina H, Miyazaki M. Evaluation of lateral lymph node dissection with preoperative chemo-radiotherapy for the treatment of advanced middle to lower rectal cancers. Int J Colorectal Dis. 2004;19:188–94.PubMedCrossRefGoogle Scholar
  33. 33.
    Mann B. Lateral lymph node dissection in rectal cancer patients: is there any indication? Int J Colorectal Dis. 2004;19:195–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Yano H, Moran BJ. The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg. 2008;95:33–49.PubMedCrossRefGoogle Scholar
  35. 35.
    Quadros CA, Falcao MF, Carvalho ME, Ladeia PA, Lopes A. Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol. 2012;106:653–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S59–68.PubMedCrossRefGoogle Scholar
  37. 37.
    Uyama I, Sugioka A, Matsui H, et al. Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer. J Am Coll Surg. 2001;193:579–84.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Heung-Kwon Oh
    • 1
  • Sung-Bum Kang
    • 1
    Email author
  • Sung-Min Lee
    • 1
  • Soo Young Lee
    • 1
  • Myoung Hun Ihn
    • 1
  • Duck-Woo Kim
    • 1
  • Ji Hoon Park
    • 2
  • Young Hoon Kim
    • 2
  • Kyung Ho Lee
    • 2
  • Jae-Sung Kim
    • 3
  • Jin Won Kim
    • 4
  • Jee Hyun Kim
    • 4
  • Tae-Young Chang
    • 5
  • Sung-Chan Park
    • 5
  • Dae Kyung Sohn
    • 5
  • Jae Hwan Oh
    • 5
  • Ji Won Park
    • 6
  • Seung-Bum Ryoo
    • 6
  • Seung-Yong Jeong
    • 6
  • Kyu Joo Park
    • 6
  1. 1.Department of Surgery, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  2. 2.Department of Radiology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  3. 3.Department of Radiation Oncology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  4. 4.Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  5. 5.Center for Colorectal Cancer, Research Institute and HospitalNational Cancer CenterGoyangKorea
  6. 6.Department of Surgery, Seoul National University College of MedicineSeoul National University HospitalSeoulKorea

Personalised recommendations