Skip to main content

Advertisement

SpringerLink
Log in

Improving prediction of lateral node spread in low rectal cancers—multivariate analysis of clinicopathological factors in 1,046 cases

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aims to search for independent predictors of lateral node metastasis in low rectal cancers.

Materials and methods

We analyzed 1,046 patients who underwent curative resection for lower rectal cancer in our prospectively collected database. All lymph nodes were dissected from the fresh specimen, and their locations were documented prospectively according to the classification by the Japanese Society of Cancer of the Colon and Rectum.

Results

More than 35% of the patients had demonstrated upward nodal metastasis in the direction of the inferior mesenteric vessels, while 11% demonstrated lateral node metastasis, which was present in 17.3% of patients with T3 and T4 lesions. Multivariate analysis revealed five factors to be statistically significant independent predictors of lateral node metastasis: female sex, tumors that were not well differentiated, pathological T3 and above, positive microscopic lymphatic invasion, and positive mesorectal nodes. Using the variables sex, differentiation, T stage, and mesorectal nodes as risk factors, because these could be elucidated preoperatively, the presence of lateral node metastasis was then analyzed according to the number of positive risk factors. When there were fewer than three positive factors, the risk of lateral nodal spread was low (4.5%). When three or more risk factors were positive, the odds of lateral node metastasis were more than 7.5 times higher (p < 0.001).

Conclusion

The findings of this study provide a scoring system that can be used to guide the clinician to the presence of lateral node metastasis in low rectal cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32(4):307–315

    Article  CAS  PubMed  Google Scholar 

  2. Fujita S, Yamamoto S, Akasu T, Moriya Y (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90(12):1580–1585

    Article  CAS  PubMed  Google Scholar 

  3. Kim TH, Jeong SY, Choi DH et al (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15(3):729–737

    Article  PubMed  Google Scholar 

  4. Mortenson MM, Khatri VP, Bennett JJ, Petrelli NJ (2007) Total mesorectal excision and pelvic node dissection for rectal cancer: an appraisal. Surg Oncol Clin N Am 16(1):177–197

    Article  PubMed  Google Scholar 

  5. Koch M, Kienle P, Antolovic D et al (2005) Is the lateral lymph node compartment relevant? Recent Results Cancer Res 165:40–45

    Article  PubMed  Google Scholar 

  6. Yano H, Moran BJ (2008) The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg 95(1):33–49

    Article  CAS  PubMed  Google Scholar 

  7. Moriya Y, Sugihara K, Akasu T, Fujita S (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21(7):728–732

    Article  CAS  PubMed  Google Scholar 

  8. Ueno M, Oya M, Azekura K et al (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92(6):756–763

    Article  CAS  PubMed  Google Scholar 

  9. Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49(11):1663–1672

    Article  PubMed  Google Scholar 

  10. Steup WH, Moriya Y, van de Velde CJ (2002) Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer 38(7):911–918

    Article  CAS  PubMed  Google Scholar 

  11. Wu ZY, Wan J, Li JH et al (2007) Prognostic value of lateral lymph node metastasis for advanced low rectal cancer. World J Gastroenterol 13(45):6048–6052

    Article  PubMed  Google Scholar 

  12. Fujita S, Yamamoto S, Akasu T, Moriya Y (2008) Outcome of patients with clinical stage II or III rectal cancer treated without adjuvant radiotherapy. Int J Colorectal Dis 23(11):1073–1079

    Article  PubMed  Google Scholar 

  13. Japanese Research Society for Cancer of the Colon and Rectum (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part II. Histopathological classification. Jpn J Surg 13(6):574–598

    Article  Google Scholar 

  14. Moriya Y, Sugihara K, Akasu T, Fujita S (1995) Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer 31A(7–8):1229–1232

    Article  CAS  PubMed  Google Scholar 

  15. Moriya Y (2006) Function preservation in rectal cancer surgery. Int J Clin Oncol 11(5):339–343

    Article  PubMed  Google Scholar 

  16. Rovera F, Dionigi G, Boni L et al (2007) The role of EUS and MRI in rectal cancer staging. Surg Oncol 16(Suppl 1):S51–S52

    Article  PubMed  Google Scholar 

  17. Nicholls RJ, Tekkis PP (2008) Multidisciplinary treatment of cancer of the rectum: a European approach. Surg Oncol Clin N Am 17(3):533–551, viii

    Article  CAS  PubMed  Google Scholar 

  18. Matsuoka H, Nakamura A, Masaki T et al (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27(5B):3529–3533

    PubMed  Google Scholar 

  19. Arii K, Takifuji K, Yokoyama S et al (2006) Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients. Langenbecks Arch Surg 391(5):449–454

    Article  PubMed  Google Scholar 

  20. Yano H, Saito Y, Takeshita E et al (2007) Prediction of lateral pelvic node involvement in low rectal cancer by conventional computed tomography. Br J Surg 94(8):1014–1019

    Article  CAS  PubMed  Google Scholar 

  21. Fujita S, Yamamoto S, Akasu T, Moriya Y (2009) Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis 24:1085–1090

    Article  PubMed  Google Scholar 

  22. Kusters M, van de Velde CJ, Beets-Tan RG et al (2009) Patterns of local recurrence in rectal cancer: a single-center experience. Ann Surg Oncol 16(2):289–296

    Article  CAS  PubMed  Google Scholar 

  23. Birgisson H, Pahlman L, Gunnarsson U, Glimelius B (2008) Late gastrointestinal disorders after rectal cancer surgery with and without preoperative radiation therapy. Br J Surg 95(2):206–213

    Article  CAS  PubMed  Google Scholar 

  24. Birgisson H, Pahlman L, Gunnarsson U, Glimelius B (2007) Late adverse effects of radiation therapy for rectal cancer—a systematic overview. Acta Oncol 46(4):504–516

    Article  PubMed  Google Scholar 

  25. Birgisson H, Pahlman L, Gunnarsson U, Glimelius B (2005) Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 23(34):8697–8705

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kok-Yang Tan, Seiichiro Yamamoto, Shin Fujita, Takayuki Akasu & Yoshihiro Moriya

  2. Department of Surgery, Alexandra Health, Singapore, Singapore

    Kok-Yang Tan

Authors
  1. Kok-Yang Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiichiro Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takayuki Akasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshihiro Moriya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiichiro Yamamoto.

Additional information

All listed authors contributed to the conception of the paper, data collection, and interpretation. All gave input during drafting and revision of the article and its final approval.

This paper is not funded by any source. There are no potential conflicts of interests of any of the authors with regards to the findings in this paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, KY., Yamamoto, S., Fujita, S. et al. Improving prediction of lateral node spread in low rectal cancers—multivariate analysis of clinicopathological factors in 1,046 cases. Langenbecks Arch Surg 395, 545–549 (2010). https://doi.org/10.1007/s00423-010-0642-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0642-1

Keywords

Search

Navigation