Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study

Kroon, Hidde M.; Malakorn, Songphol; Dudi-Venkata, Nagendra N; Bedrikovetski, Sergei; Liu, Jianliang; Kenyon-Smith, Tim; Bednarski, Brian Keith; Ogura, Atsushi; Velde, Cornelis J.H. van de; Rutten, H.J.T.; Beets, Geerard L.; Thomas, Michelle; Kusters, Miranda; Chang, George J.; Sammour, Tarik

doi:10.1016/j.ejso.2021.06.004

Cited by 26 publications

(27 citation statements)

References 32 publications

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“…Some consider lateral nodal disease to represent metastatic disease that is not amenable to treatment, and persistently enlarged lateral nodes after chemoradiotherapy indicate a high risk of local recurrence [19]. Lateral lymph node dissection may improve locoregional control in patients with low rectal cancer and abnormal lateral LNs, but larger studies are warranted [20].…”

Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

Grimm

Loft

Dam

et al. 2021

Cancers

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Colorectal cancer is the second most common cancer in Europe, and accurate lymph node staging in rectal cancer patients is essential for the selection of their treatment. MRI lymph node staging is complex, and few studies have been published regarding its reproducibility. This study assesses the inter- and intraobserver variability in lymph node size, apparent diffusion coefficient (ADC) measurements, and morphological characterization among inexperienced and experienced radiologists. Four radiologists with different levels of experience in MRI rectal cancer staging analyzed 36 MRI scans of 36 patients with rectal adenocarcinoma. Inter- and intraobserver variation was calculated using interclass correlation coefficients and Cohens-kappa statistics, respectively. Inter- and intraobserver agreement for the length and width measurements was good to excellent, and for that of ADC it was fair to good. Interobserver agreement for the assessment of irregular border was moderate, heterogeneous signal was fair, round shape was fair to moderate, and extramesorectal lymph node location was moderate to almost perfect. Intraobserver agreement for the assessment of irregular border was fair to substantial, heterogeneous signal was fair to moderate, round shape was fair to moderate, and extramesorectal lymph node location was substantial to almost perfect. Our data indicate that subjective variables such as morphological characteristics are less reproducible than numerical variables, regardless of the level of experience of the observers.

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Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

Grimm

Loft

Dam

et al. 2021

Cancers

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“…An important caveat of this study was that those who underwent LLN sampling only and not regional lymphadenectomy (LPLD) showed a very high rate of lateral recurrence (around 50%) [ 25 ]. Another recent multicenter comparative study also showed that LPLD was an independent risk factor for LR on multivariable analysis [ 47 ]. Our study showed consistent findings with previous reports that LPLD reduced the 5-year LR rate from 27.9% to 4.6%.…”

Section: Discussionmentioning

confidence: 99%

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review

Kim

2021

Ann Coloproctol

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Purpose: We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).Methods: We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.Results: The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).Conclusion: This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

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“…According to the Japanese guidelines, PLND is mandatory when the lower border of the tumor is located distal to the peritoneal reflection, and the tumor has invaded beyond the muscularis propria [ 24 ]. Regarding the size criteria, the definition of abnormal LPLNs varies between a short axis of 5 to 10 mm [ 137 ]. Pre-NCRT LLNs of > 5 mm short axis are present in 16% to 23% of patients with a primary locally advanced low rectal cancer.…”

Section: Debated Issuesmentioning

confidence: 99%

“…Pre-NCRT LLNs of > 5 mm short axis are present in 16% to 23% of patients with a primary locally advanced low rectal cancer. Although the prognosis of these cases is poor, in general, 40% to 50% of patients with R0 resection reportedly achieved 5‐year survival [ 137 ].…”

Section: Debated Issuesmentioning

confidence: 99%

“…A propensity score matching analysis of pT3/T4 lower rectal cancer cases in the Japanese Society for Cancer of the Colon and Rectum (JSCCR) colorectal cancer registry from 1995 to 2004 also showed that the 5‐year overall survival rate of patients with lateral LN dissection was better than that of those without dissection (68.9% vs. 62.0%) [ 137 ]. Thus, even in cases in which preoperative chemoradiotherapy is performed, the omission of lateral LN dissection is not recommended.…”

Section: Debated Issuesmentioning

confidence: 99%

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Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study

Cited by 26 publications

References 32 publications

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review

Surgical Treatment of Low-Lying Rectal Cancer: Updates

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