Fat clearance and conventional fixation identified ypN0 rectal cancers following intermediate neoadjuvant radiotherapy have similar long-term outcomes

Abstract

BACKGROUNDAs a prognostic factor for colorectal cancer, lymph node (LN) status, particularly the number of LN harvested, has been demonstrated to be essential in the evaluation of quality control in terms of surgical specimen. Neoadjuvant chemoradiation, however, decreases the LN harvest. Therefore, certain approaches (such as fat clearance or methylene blue) has drawn significant attention in order to raise LN yield.AIMTo compare the long-term oncologic outcome of ypN0 rectal cancer identified using fat clearance (FC) or conventional fixation (CF) following 30 Gy in 10 fractions (30 Gy/10f) of neoadjuvant radiotherapy (nRT).METHODSThree hundred and eighty-two patients with resectable and locally advanced rectal cancer were treated by 30 Gy/10f intermediate nRT (biologically equivalent dose of 36 Gy) plus total mesorectal excision. Two specimen fixation methods (FC or CF) were non-randomly used. The ypN0 status was identified in 124 and 101 patients in the FL and CF groups, respectively. Primary endpoints were local recurrence-free survival (LRFS) and cancer-specific survival (CSS).RESULTSThe median follow-up of patients was 5.1 years. The median numbers of retrieved LNs in the FC and CF groups were 19.5 (range, 4-47) and 12 (range, 0-44), respectively, with a significant difference (P = 0.000). The percentages of patients with 12 or more retrieved nodes were 82.3% and 50.5% (101/159) in the FC and CF groups, respectively, with a significant difference (P = 0.000). The LRFS at 5 years were 95.7% and 94.6% in the FC and CF groups, respectively, without statistical difference (P = 0.819). The CSS at 5 years were 92.0% and 87.2% in the FC and CF groups, respectively, without statistical difference (P = 0.482).CONCLUSIONFor patients with ypN0 rectal cancer who underwent 30 Gy/10f preoperative radiotherapy, the increased retrieval of LNs using fat clearance is not associated with survival benefit. This time-consuming fixation method has a low efficacy as a routine practice.

The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection

“…It was also shown that fat clearance increased the median number of retrieved lymph nodes in ypN0 rectal cancer patients from 12 to 19.5 compared to the conventional fixation method. However, it did not affect the long-term outcomes [ 39 ]. Thus, technical factors (both surgical and histological) seem to be of secondary importance in terms of understaging.…”

The Assessment of Risk Factors for Long-term Survival Outcome in ypN0 Patients With Rectal Cancer After Neoadjuvant Therapy and Radical Anterior Resection

“…It was also shown that fat clearance increased the median number of retrieved lymph nodes in ypN0 rectal cancer patients from 12 to 19.5 compared to the conventional xation method. However, it did not affect the long-term outcomes [32]. Thus, technical factors (both surgical and histological) seem to be of secondary importance in terms of understaging, particularly in centers experienced in colorectal surgery.…”