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Annals of Surgical Oncology

, Volume 24, Issue 13, pp 3850–3856 | Cite as

Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer

  • Yuichiro Miyake
  • Tsunekazu Mizushima
  • Taishi Hata
  • Hidekazu Takahashi
  • Hiroyuki Hanada
  • Hiroki Shoji
  • Masatoshi Nomura
  • Naotsugu Haraguchi
  • Junichi Nishimura
  • Chu Matsuda
  • Ichiro Takemasa
  • Yuichiro Doki
  • Ikuhiro Maeda
  • Masaki Mori
  • Hirofumi YamamotoEmail author
Colorectal Cancer

Abstract

Background

Lateral lymph node dissection (LLND) is performed for advanced rectal cancers in Japan; however, it can cause sexual and urinary dysfunction. The incidence of lateral LN metastasis is estimated at 7–13.9%; therefore, excessive rectal surgery with LLND should be avoided, especially for prophylactic purposes. To identify the patients who require LLND, we examined metastases in perirectal LNs by using a one-step nucleic acid amplification (OSNA) assay to predict lateral LN metastases.

Methods

Twenty-five patients who underwent surgery with bilateral LN dissection due to T3–T4 rectal cancers were prospectively included in this study. Twenty-two patients (88.0%) received preoperative chemotherapy. Among 1052 LNs from 25 patients (median 40 per case), 135 perirectal LNs (median 6 per patient) were divided into three pieces and analyzed by OSNA, reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen mRNA, and pathological examination after surgery. These results were compared with the pathological diagnosis of lateral LNs.

Results

Lateral LN metastases were present in 4 of 25 patients (16.0%). All of these patients were positive by OSNA for perirectal LN metastases. The OSNA assay had a sensitivity of 100%, specificity of 86%, positive predictive value of 57%, and negative predictive value (NPV) of 100% for predicting lateral LN metastases.

Conclusions

The findings from this prospective study suggest that the OSNA assay of perirectal LNs may be useful for determining when LLND is necessary because of its high NPV, even in patients treated with preoperative chemotherapy.

Notes

ACKNOWLEDGEMENTS

The authors thank the many doctors and coworkers at the Gastroenterological Surgery department, Osaka University, for their helpful contributions to this study.

Funding

Funded by the Japan Society for The Promotion of Science; JSPS KAKENHI (Grant-in-Aid for Scientific Research [C]) Grant Number JP 25462055.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Yuichiro Miyake
    • 1
  • Tsunekazu Mizushima
    • 1
  • Taishi Hata
    • 1
  • Hidekazu Takahashi
    • 1
  • Hiroyuki Hanada
    • 2
  • Hiroki Shoji
    • 2
  • Masatoshi Nomura
    • 1
  • Naotsugu Haraguchi
    • 1
  • Junichi Nishimura
    • 1
  • Chu Matsuda
    • 1
  • Ichiro Takemasa
    • 3
  • Yuichiro Doki
    • 1
  • Ikuhiro Maeda
    • 2
  • Masaki Mori
    • 1
  • Hirofumi Yamamoto
    • 1
    • 4
    Email author
  1. 1.Department of Surgery, Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuita CityJapan
  2. 2.Laboratory for Clinical InvestigationOsaka University HospitalSuita CityJapan
  3. 3.Department of SurgerySurgical Oncology and Science, Sapporo Medical UniversitySapporo CityJapan
  4. 4.Department of Molecular Pathology, Division of Health Sciences, Graduate School of MedicineOsaka UniversitySuita CityJapan

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