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Impact of Lateral Pelvic Lymph Node Dissection on the Survival of Patients with T3 and T4 Low Rectal Cancer

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Abstract

Background

The aim of this study was to clarify the survival benefit of lateral pelvic lymph node dissection (LPLND) for patients with pathological T3 and T4 (pT3/T4) low rectal cancer.

Methods

We evaluated the impact of LPLND on survival for pT3/T4 low rectal cancer patients. The primary endpoint of the study was overall survival (OS). The large-scale database of the Japanese Society for Cancer of the Colon and Rectum registration system was accessed and the data were analyzed using a propensity score matching method based on the likelihood of receiving LPLND. Using seven covariates, the propensity scores were calculated with multivariate logistic regression. A total of 499 propensity score-matched pairs of patients were selected from the entire cohort of 1,840 patients who had received curative resection for pT3/T4 low rectal cancer between 1995 and 2004.

Results

In the matched cohort, the 5-year OS of the patients who had and had not undergone LPLND were 68.9 and 62.0 %, respectively (p = 0.013; hazard ratio [HR], 0.755; 95 % confidence interval [CI], 0.604–0.944). The 5-year OS of the patients with node-negative disease who had and had not received LPLND differed statistically significantly (5-year OS were 82.1 and 71.4 %, respectively. p = 0.006; HR, 0.579; 95 % CI 0.389–0.862). However, those with node-positive disease did not differ significantly (5-year OS were 55.5 and 53.8 %, respectively. p = 0.415; HR 0.893; 95 % CI 0.681–1.172).

Conclusions

The impact of LPLND on OS for patients with node-negative pT3/T4 low rectal cancer was suggested in this retrospective cohort study. To determine true benefits and harms of LPLND, further prospective studies may be warranted.

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Authors and Affiliations

  1. Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan

    Heita Ozawa, Kenjiro Kotake, Miki Hosaka & Akira Hirata

  2. Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, 113-8519, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Heita Ozawa
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  2. Kenjiro Kotake
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  3. Miki Hosaka
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  4. Akira Hirata
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  5. Kenichi Sugihara
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Correspondence to Heita Ozawa.

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The authors declare that they have no conflict of interest and grant support.

Ethics approval

Ethics approval was obtained from the Tochigi Cancer Center’s institutional review board, and for this type of study formal consent is not required.

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Ozawa, H., Kotake, K., Hosaka, M. et al. Impact of Lateral Pelvic Lymph Node Dissection on the Survival of Patients with T3 and T4 Low Rectal Cancer. World J Surg 40, 1492–1499 (2016). https://doi.org/10.1007/s00268-016-3444-y

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  • DOI: https://doi.org/10.1007/s00268-016-3444-y

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