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Oncologic Status of Obturator Lymph Node Metastases in Locally Advanced Low Rectal Cancer: A Japanese Multi-Institutional Study of 3487 Patients

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

Abstract

Background

The American Joint Committee on Cancer tumor-node-metastasis staging system for rectal cancer defines lateral pelvic lymph nodes (LPLNs) only in the internal iliac region as regional. However, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) staging system, also considers obturator lymph nodes (LNs) as regional. This retrospective cohort study evaluated the oncologic status of obturator LNs in low rectal cancer.

Methods

The study identified 3487 patients with pT3-T4 low rectal cancer who had undergone curative resections without preoperative radiotherapy or chemotherapy between 2003 and 2011 in the JSCCR database and divided them into six groups. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by groups.

Results

Histologic LPLN metastases were identified in 8% (279/3487) of all the patients and in 18.2% (279/1530) of the patients who underwent lateral pelvic node dissection. The 5-year OS and RFS rates of the obturator-LPLN group (P = 0.095) were worse than those of the internal-LPLN group (P = 0.075), but the difference was not significant. The OS of the obturator-LPLN group was similar to that of the resectable liver metastasis group (P = 0.731), and the RFS of the obturator-LPLN group was significantly better than that of the other-LPLN group (P = 0.016).

Conclusion

The prognosis for obturator LN metastases in low rectal cancer was not significantly worse than for internal iliac LN metastases, defined as regional by the current American Joint Committee on Cancer staging system, and the oncologic status of obturator LNs warrants more studies.

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Acknowledgment

Dr. Zhifen Chen was financially supported by the National Clinical Key Specialty Construction Project (General Surgery) of China (Grant No. 2012-649) and sponsored by the Fujian Medical University Union Hospital to study at the University of Tokyo Hospital. The authors thank all members and staff of the JSCCR member institutions for collecting data for the Japanese Colorectal Cancer Registry. The authors also thank Editage (www.editage.cn) for English language editing.

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Author notes

  1. Zhifen Chen and Kazuhito Sasaki these authors contributed equally to this article.

Authors and Affiliations

  1. Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan

    Zhifen Chen MD, PhD, Kazuhito Sasaki MD, PhD, Koji Murono MD, PhD, Kazushige Kawai MD, PhD, Hioaki Nozawa MD, PhD & Soichiro Ishihara MD, PhD

  2. Department of Surgery, Teikyo University, Mizonokuchi Hospital, Kawasaki-city, Kanagawa, Japan

    Hirotoshi Kobayashi MD, PhD

  3. Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

    Kenichi Sugihara MD, PhD

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  1. Zhifen Chen MD, PhD
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On behalf of the Japanese Society for Cancer of the Colon and Rectum

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Correspondence to Soichiro Ishihara MD, PhD.

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This article was partially submitted to the 14th Chinese Academic Congress of Colorectal Surgery in conjunction with the International Summit of Colorectal Surgery as poster which was held in Shanghai, China, on October 15 to 17, 2021.

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Chen, Z., Sasaki, K., Murono, K. et al. Oncologic Status of Obturator Lymph Node Metastases in Locally Advanced Low Rectal Cancer: A Japanese Multi-Institutional Study of 3487 Patients. Ann Surg Oncol 29, 4210–4219 (2022). https://doi.org/10.1245/s10434-022-11372-z

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