Distribution of lymph nodes in the mesorectum: how deep is TME necessary?

Perez, Rodrigo Oliva; Seid, Víctor Edmond; Bresciani, Erica; Bresciani, Claudio; Proscurshim, Igor; Pereira, Diego Daniel; Kruglensky, D.; Rawet, Viviane; Habr‐Gama, Angelita; Kiss, Desidério Roberto

doi:10.1007/s10151-008-0396-8

Cited by 15 publications

(12 citation statements)

References 26 publications

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“…Koh et al 13 , examining the distribution of mesorectal lymph nodes based on imaging and histopathology, hardly found any lymph nodes distal to the tumor. This in contrast to an anatomical cadaver study of Perez et al 14 , who found lymph nodes up to the distal third of the mesorectum. However, several studies reported distal mesorectal spread in 10-15% of rectal cancer patients, usually within 2-3 cm and more often in the form of small mesorectal deposits than involved nodes [10][11][12] .…”

Section: A C C E P T E D Article In Presscontrasting

confidence: 53%

Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial

Kusters

Marijnen

Velde

et al. 2010

European Journal of Surgical Oncology (EJSO)

287

197

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Aim of the study: In patients from the Dutch TME trial patterns of local recurrence (LR) in rectal cancer were studied. The purpose was to reconstruct the most likely mechanisms of LR and the effect of preoperative radiotherapy.Methods: 1417 patients were analyzed; 713 were randomized into preoperative radiotherapy and total mesorectal excision (RT+TME), 704 into TME alone. Of the 114 patients with LR, the subsites of LR were determined and related to tumor and treatment factors. Results:Overall 5-year LR-rate was 4.6% in the RT+TME group and 11.0% in the TME group.Presacral local recurrences occurred most in both groups. Radiotherapy reduced anastomotic LR significantly, except when after low anterior resection (LAR) distal margins were less than 5 mm.Abdominoperineal resection (APR) mainly resulted in presacral LR. Even after resection with a negative circumferential resection margin, LR rates were high. 30% of the patients had advanced tumors, which resulted in 58% of all LRs. Lateral LR comprised 20% of all LR. Presacral LR resulted in a poor prognosis, in contrast to anterior or anastomotic LRs with a relatively good prognosis. Conclusions:RT reduces LR in all subsites and is especially effective in preventing anastomotic LR after LAR. APR surgery mainly results in presacral LR, which may be prevented by a wider resection.In the TME trial many advanced tumors were included, rather requiring chemoradiotherapy in stead of RT. Currently, with good imaging techniques, better selection can take place. Especially lateral LR might be a problem in the future.

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Section: A C C E P T E D Article In Presscontrasting

confidence: 53%

Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial

Kusters

Marijnen

Velde

et al. 2010

European Journal of Surgical Oncology (EJSO)

287

197

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“…The majority of local recurrences historically reflected inadequate mesorectal resection [34], which is a common finding on postoperative MRI after partial mesorectal excision [35]. Careful dissection particularly in the posterior aspect of a TME specimen with its higher prevalence of lymph nodes is important [36]. Currently, optimal qualitycontrolled surgery in terms of TME in the trial setting can be associated with local recurrence rates of less than 10% whether patients receive radiotherapy or not [37].…”

Section: Mri Staging Of Rectal Cancermentioning

confidence: 99%

Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer

Lutz

Zalcberg

Glynne‐Jones

et al. 2016

European Journal of Cancer

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Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence. The treatment strategy for localised rectal cancer varies from local excision in early tumours to neoadjuvant radiochemotherapy (RCT) in combination with extended surgery in locally advanced disease. Optimal pretherapeutic staging is a key to any treatment decision. The panel recommended magnetic resonance imaging (MRI) or MRI + endoscopic ultrasonography (EUS) as mandatory staging modalities, except for early T1 cancers with an option for local excision, where EUS in addition to MRI was considered to be most important because of its superior near-field resolution. Primary surgery with total mesorectal excision was recommended by most panellists for some early tumours with limited risk of recurrence (i.e. cT1-2 or cT3a N0 with clear mesorectal fascia on MRI and clearly above the levator muscles), whereas all other stages were considered for multimodal treatment. The consensus panel recommended long-course RCT over short-course radiotherapy for most clinical situations where neoadjuvant treatment is indicated, with the exception of T3a/b N0 tumours where short-course radiotherapy or even no neoadjuvant therapy were regarded to be an option. In patients with potentially resectable tumours and synchronous liver metastases, most panel members did not see an indication to start with classical fluoropyrimidine-based RCT but rather favoured preoperative short-course radiotherapy with systemic combination chemotherapy or alternatively a liver-first resection approach in resectable metastases, which both allow optimal systemic therapy for the metastatic disease. In general, proper patient selection and discussion in an experienced multidisciplinary team was considered as crucial component of care.

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“…Another suggestion is that individual variation in the number of mesenteric LNs may reflect variations in immune competence. Anatomical studies have shown considerable individual variation in the number of LNs recovered from the mesorectum [49][50][51][52][53] but similar studies on the mesocolon have not as yet been reported.…”

Section: Factors Influencing Lny and Survival In Crcmentioning

confidence: 98%