Fewer Than 12 Lymph Nodes Can be Expected in a Surgical Specimen After High-Dose Chemoradiation Therapy for Rectal Cancer

Marks, John; Valsdóttir, Elsa B.; Rather, Assar A.; Nweze, Ikenna; Newman, Donald A.; Chernick, Michael R.

doi:10.1007/dcr.0b013e3181dadeb4

Cited by 72 publications

(39 citation statements)

References 25 publications

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“…A study from our institution showed that after neoadjuvant therapy, the mean lymph node harvest is 10.1 (range, 1-38), which coincides with our data [16]. The mean specimen length was 33.7 cm (range, 16-117 cm).…”

Section: Pathologysupporting

confidence: 77%

Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy

et al. 2010

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The study results indicate excellent local recurrence (2.7%) and 5-year survival rates without the need for permanent colostomy in patients with cancers in the distal one-third of the rectum. Laparoscopic total mesorectal excision (TME) with the TATA approach is safe and can be performed laparoscopically. Multi-institutional studies are required to establish the reproducibility of this promising approach.

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Section: Pathologysupporting

confidence: 77%

Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy

et al. 2010

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“…The normal mesorectal fibro-fatty tissue also atrophies due to radiation induced fibrosis. These factors confound to make it difficult to recognize lymph nodes in irradiated specimen by gross examination (17,32,34,35). In addition, the lymphoid tissue is highly sensitive to radiation and shows more rapid apoptosis, leading to more favourable response than rectal wall thickness (36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

“…Although, the standardized treatment including preoperative chemo-radiation followed by TME and complete pathological evaluation is unanimously followed worldwide, but the number of lymph nodes harvested varies greatly with ranging 29% to 72% (17,(29)(30)(31)39,40).…”

Section: Discussionmentioning

confidence: 99%

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Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

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Background: The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response. Methods: We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had <12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment. Results: Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P<0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40% vs. 26%, P<0.05) in group 2. As per Mandard criteria, there was significant difference in tumor regression grade (TRG) between both the groups (P<0.05). Among patients with metastatic lymph nodes, median LNR was lower in <12 lymph nodes group at 0.167 (range, 0.09-0.45) versus 0.187 (range, 0.05-0.54), difference was not statistically significant (P=0.81).Conclusions: Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

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“…Following a retrospective analysis of 1098 patients who underwent CRC resection, Thomas and colleagues 17 found that 41% were staged as Dukes C. Sixty-four percent of their patients received chemotherapy. Of the patients who received chemotherapy, 5-year survival was 22 and the number of harvested LNs was frequently less than 12. Lee and colleagues 15 found that fewer than 12 LNs were harvested in 30.5% of patients after preoperative CRT.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

Zhou

Bai

et al. 2015

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Background:The lymph node ratio (LNR) has been shown to be an important prognostic factor in patients with gastric, breast, pancreatic and colorectal cancer. We investigated the prognostic impact of the LNR in addition to TNM classification in patients with locally advanced rectal cancer. Methods:We retrospectively analyzed patients who underwent curative resection for locally advanced rectal cancer between July 2005 and December 2010. We determined the LNR cutoff value using a receiver operating characteristic curve. The Kaplan-Meier method was used to estimate survival curves, while Cox regression analyses were used to evaluate the relationship between LNR and survival. Results:We included 180 patients aged 28-83 years with median follow-up of 41.8 months. The median number of lymph nodes examined and lymph nodes involved were 11.5 and 4, respectively, and the median LNR was 0.366. An LNR of 0.19 (19%) was the cutoff point to separate patients with regard to median overall survival. Median overall survival was 64.2 months for patients with an LNR of 0, 59.1 for an LNR of 0.19 or less and 37.6 for an LNR greater than 0.19 (p = 0.004). The median disease-free survival was 32.9 months for patients with an LNR of 0, 30.4 for an LNR of 0.19 or less and 17.8 for an LNR greater than 0.19 (p = 0.002). Conclusion:Our results suggest that LNR should be considered an additional prognostic factor in patients with locally advanced rectal cancer.Contexte : Il a été démontré que le ratio de ganglions lymphatiques positifs est un important facteur pronostique chez les patients atteints de cancer de l'estomac, de cancer du sein, de cancer du pancréas et de cancer colorectal. Nous avons étudié l'incidence pronostique de l'utilisation de ce ratio en plus de la classification TNM chez les patients présentant un cancer du rectum localement avancé.Méthodes : Nous avons analysé rétrospectivement des patients ayant subi une résec-tion curative visant à traiter un cancer du rectum localement avancé entre juillet 2005 et décembre 2010. Nous avons déterminé la valeur seuil du ratio de ganglions lymphatiques positifs à l'aide d'une courbe caractéristique de la performance. La méthode de Kaplan-Meyer a été utilisée pour estimer les courbes de survie, tandis que le modèle de régression des hasards proportionnels de Cox a servi à évaluer la corréla-tion entre le ratio à l'étude et la survie.Résultats : Notre étude a porté sur 180 patients de 28 à 83 ans dont la durée mé diane du suivi était de 41,8 mois. Les nombres médians de ganglions lymphatiques examinés et de ganglions lymphatiques positifs étaient de 11,5 et 4, respectivement, et le ratio médian de ganglions lymphatiques positifs était de 0,366. Nous avons utilisé une valeur seuil de 0,19 (19 %) pour séparer les patients en ce qui a trait à la survie globale médiane. Cette mesure était de 64,2 mois pour les patients présentant un ratio de 0, de 59,1 mois pour ceux présentant un ratio de 0,19 ou moins, et de 37,6 mois pour ceux dont le ratio était supérieur à 0,19 (p = 0,004). La survi...

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Fewer Than 12 Lymph Nodes Can be Expected in a Surgical Specimen After High-Dose Chemoradiation Therapy for Rectal Cancer

Abstract: With a standardized surgical technique and pathologic evaluation, the number of lymph nodes present after neoadjuvant chemoradiation and total mesorectal excision for rectal cancer varies greatly.

Cited by 72 publications

References 25 publications

Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy

Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

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