Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer

Ueno, Masashi; Oya, Mototsugu; Azekura, Kaoru; Yamaguchi, Toshiharu; Muto, Tetsuichiro

doi:10.1002/bjs.4975

Cited by 240 publications

(170 citation statements)

References 21 publications

Supporting

Mentioning

155

Contrasting

Order By: Relevance

“…The incidence of LPLN-positive status (18.3%) in our study was similar to that of pathological LPLN metastasis of previous reports, in which patients underwent surgery alone (1)(2)(3)(4)(5). Following preoperative CRT, 7 of the 19 (36.8%) initially LPLN-positive patients exhibited LPLN downsizing to <7 mm; none of these 7 patients developed recurrence.…”

Section: Discussionsupporting

confidence: 89%

“…LPLN dissection is often performed with TME in advanced low RC in Japan, as TME does not remove LPLN, which may contain metastasis and lead to local recurrence. The incidence of LPLN metastasis is reportedly 10-20% in patients with advanced low RC who undergo LPLN dissection (1)(2)(3)(4)(5). Although a retrospective analysis has suggested that LPLN dissection is equivalent to preoperative CRT in terms of local control for patients with lower RC (6), the effect of preoperative CRT on patients with involved LPLN has not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

View full text Add to dashboard Cite

Abstract. Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

View full text Add to dashboard Cite

show abstract

“…It was reported that local recurrence can be found in 4%-50% of patients with rectal carcinoma after curative resection, and lateral lymph node metastasis may be the important factor for local recurrence [15,16] . Ueno et al [15] reported that patients with lateral node metastases have an increased risk for local recurrence (44% vs 11.7%; P < 0.001) compared with those without lateral node metastases. Sugihara et al [16] also reported that positive lateral lymph nodes are significantly associated with increased local recurrence of rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The survival of patients with advanced low rectal cancer www.wjgnet.com still remains poor. It was reported that lateral lymph node metastasis may be the most important factor for local recurrence and poor prognosis of advanced low rectal cancer [15][16][17][18] . In the current study, the data on 96 consecutive patients who underwent curative surgery with total mesorectal excision and lateral lymph node dissection for advanced low rectal cancer at the Department of General Surgery of Guangdong Provincial People's Hospital were retrospectively analyzed.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

Zeyu¹,

Wu²,

Jin³

et al. 2007

WJG

View full text Add to dashboard Cite

AIM:To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHOD S :A t o t a l o f 9 6 c o n s e c u t i v e p a t i e n t s who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS:Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (χ 2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ 2 = 27.944, P = 0.0001).The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ 2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (χ 2 = 22.308, P = 0.0001).Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95%CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION:Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

show abstract

“…1,2 Although the data as well as the attached video were excellent, one important aspect that deserves further comment is discussion regarding combined resection of the iliac vessels.…”

Section: To the Editorsmentioning

confidence: 98%

Combined Resection of the Iliac Vessels for Lateral Pelvic Lymph Node Dissection can be Safely Performed Through Laparoscopic Approach

2011

View full text Add to dashboard Cite

TO THE EDITORS:We read with interest the article by Liang, who reported technical feasibility of laparoscopic lateral pelvic lymph node dissection (LPLND) for lower rectal cancer after concurrent chemoradiation, citing data from our institution. 1,2Although the data as well as the attached video were excellent, one important aspect that deserves further comment is discussion regarding combined resection of the iliac vessels.There are three important lateral pelvic regions highly involved by metastasis of lower rectal cancer: the obturator region, the internal iliac artery region, and the internal pudendal artery region. 3 In particular, the internal pudendal artery region, which is the periphery of the internal iliac artery, is the most frequent site for metastasis that accounts for 56% of lateral pelvic metastasis.3 Consequently, as Liang discussed, combined resection of the iliac vessels is required to obtain sufficient surgical margin when nodal involvement exists grossly in this region.2,3 However, Liang concluded that combined resection of the iliac vessels was currently too difficult to perform laparoscopically.We have recently reported 14 cases that underwent laparoscopic LPLND for lower rectal cancer after concurrent chemoradiation.4 Notably, 11 of the cases underwent combined resection of the iliac vessels in order to perform complete dissection of the internal pudendal artery region. All procedures were successfully performed without conversion to open surgery, and median blood loss and operation time were 25 ml and 413 minutes, respectively. Importantly, median number of retrieved lymph nodes was 23, which was much higher than Liang's data. Consistent with Liang's data, postoperative recovery was excellent with median flatus passage of one day. Autonomic nerve was carefully preserved in all cases, and consequently, there was no urinary dysfunction. According to these data, we would conclude that combined resection of the iliac vessels can be safely performed through laparoscopic approach.Liang's excellent data, as well as our data, clearly indicate that the laparoscopic approach brings much better short-term outcomes than the traditional open approach for LPLND. In the light of finding that LPLND for lower rectal cancer achieves 45-75% five-year-survival even in the presence of lateral pelvic metastasis, laparoscopic LPLND would be the next promising challenge that could not only provide survival benefit but also minimize bleeding and postoperative complications with enhanced visualization. 2,3,5 With acceptance on this point, further recruitment of the patients is justified, and long-term follow-up is needed to clarify the oncological outcomes of this procedure.

show abstract

Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer

Abstract: Tumour site, histological type and the presence of mesenteric lymph node metastasis are factors predicting the risk of lateral node metastasis. The poor prognosis of patients with lateral lymph node metastases after systematic lateral dissection suggests the need for adjuvant therapy.

Cited by 240 publications

References 21 publications

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

Combined Resection of the Iliac Vessels for Lateral Pelvic Lymph Node Dissection can be Safely Performed Through Laparoscopic Approach

Contact Info

Product

Resources

About