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Local Recurrence in the Lateral Lymph Node Compartment: Improved Outcomes with Induction Chemotherapy Combined with Multimodality Treatment

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lateral nodal disease is of major importance in the treatment of rectal cancer in the East, but a mostly neglected entity in the West. In this article, the treatment of recurrences in the lateral compartment (latLRs) in a national tertiary referral center is evaluated.

Methods

Of 214 patients with locally recurrent rectal cancer who underwent multimodality treatment in the Catharina Hospital in the last 10 years, a total of 51 patients with latLR were selected (the latLR region was classified as upper, middle, or lower). Thirteen (25 %) of these patients underwent induction chemotherapy (ICT) prior to chemo(re)irradiation.

Results

LatLRs occurred mainly after low and N+ primary tumors. Seven (14 %) patients had a complete response (pCR) and 28 (55 %) underwent an R0 resection. Patients with a lower latLR had the highest chance of undergoing an abdominoperineal resection and resection of anterior organs. ICT resulted in a 31 % pCR rate compared with 8 % without ICT (p = 0.039). Patients who received ICT had an 85 % R0 resection rate, while this was 45 % in patients who did not receive ICT (p = 0.013). The 5-year local re-recurrence (LRR) rate was 64.3 %, and overall survival (OS) was 34.2 %; the only factor improving these was an R0 resection. Five-year survival after multivariate analyses was 10.3 % after an R+ resection compared with 66.8 % after an R0 resection (p = 0.011).

Conclusions

LatLRs impose a major surgical challenge and result in high LRR and low OS. More R0 resections can possibly be achieved with ICT, which is the only factor that can improve LRR and OS.

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Authors and Affiliations

  1. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Miranda Kusters MD, PhD, Sietske J. Bosman MD, Desley M. G. I. Van Zoggel MSc, Grard A. P. Nieuwenhuijzen MD, PhD & Harm J. T. Rutten MD, PhD

  2. Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands

    Geert-Jan Creemers MD, PhD

  3. Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands

    Hetty A. Van den Berg MD, PhD

  4. Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands

    Harm J. T. Rutten MD, PhD

Authors
  1. Miranda Kusters MD, PhD
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  2. Sietske J. Bosman MD
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  3. Desley M. G. I. Van Zoggel MSc
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  4. Grard A. P. Nieuwenhuijzen MD, PhD
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  6. Hetty A. Van den Berg MD, PhD
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  7. Harm J. T. Rutten MD, PhD
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Correspondence to Miranda Kusters MD, PhD.

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Kusters, M., Bosman, S.J., Van Zoggel, D.M.G.I. et al. Local Recurrence in the Lateral Lymph Node Compartment: Improved Outcomes with Induction Chemotherapy Combined with Multimodality Treatment. Ann Surg Oncol 23, 1883–1889 (2016). https://doi.org/10.1245/s10434-016-5098-2

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  • DOI: https://doi.org/10.1245/s10434-016-5098-2

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