The Effect of Preoperative Chemoradiotherapy on Lymph Node Harvest After Total Mesorectal Excision for Rectal Cancer

Taflampas, Panagiotis; Christodoulakis, Manousos; Gourtsoyianni, Sofia; Leventi, Aikaterini; Melissas, John; Tsiftsis, D

doi:10.1007/dcr.0b013e3181a0e6ac

Cited by 20 publications

(12 citation statements)

References 22 publications

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“…Our results are also in accordance with these trends. However, the mean total number of retrieved lymph nodes after preop-CRT ranged from 7 to 14.3 in other studies and the proportion of those with fewer than 12 examined lymph nodes were higher than our results [7,8]. The reason for these diverse retrieved lymph node numbers between studies is not fully understood.…”

Section: Discussioncontrasting

confidence: 83%

“…A previous report by our study revealed that the mean retrieved lymph node numbers was 24.8 AE 13.6 in stage III rectal cancer patients who underwent tumor-specific mesorectal excision with curative intent and adjuvant chemoradiation [11]. It was reported that the total number of retrieved lymph nodes may decrease or the proportion of those with fewer than 12 examined lymph nodes may increase after a long course of preop-CRT in rectal cancer [6][7][8]. Our results are also in accordance with these trends.…”

Section: Discussionmentioning

confidence: 85%

“…Adequate examination of the regional lymph node plays a pivotal role in the prediction of patient prognosis, as persistent metastasis in regional lymph nodes after preop-CRT is the most important prognostic factor in these patients [4,5]. However, it is well known that the total retrieved lymph node numbers or the proportion of more than 12 examined lymph node numbers may decrease after a long course of preop-CRT [6][7][8].…”

Section: Introductionmentioning

confidence: 98%

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Prognostic impact of the Lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation

Kang

Hur

Min

et al. 2011

Journal of Surgical Oncology

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 98%

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Prognostic impact of the Lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation

Kang

Hur

Min

et al. 2011

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 87%

“…In other trials, lymph node retrieval after nCRT also appeared to be lower (1,20,27). Besides, it was reported that chemoradiotherapy reduced lymph node harvest from within the radiotherapy field in rectal cancer (28,29).Most previous studies revealed nCRT was not associated with improved survival in spite of its apparent elevated pCR rate compared with nCT (3,20,21,25). It was worth mentioning that nCRT group carried an increased risk of postoperative mortality or had more deaths unrelated to disease progression in the first-year follow up period in these studies.…”

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confidence: 90%

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

et al. 2018

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Background: Few studies reported the outcomes of minimally invasive esophagectomy (MIE) in treating patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT).The aim of the study was to investigate the feasibility and efficacy of nCRT plus MIE (RM) strategy in treating locally advanced resectable ESCC.Methods: This retrospective study included 175 patients with ESCC undergoing surgical resection after neoadjuvant therapy in our institution from 2010 to 2016. Patients were stratified into three groups: RM, [neoadjuvant chemotherapy (nCT) plus MIE] (CM) and [nCT plus open esophagectomy (OE)] (CO).Results: Seventy-six (43.4%), 42 (24%) and 57 (32.6%) patients received RM, CM and CO approach, There were no differences in 30-and 90-day mortality among all groups. RM approach was more likely to achieve pathological complete regression (27.6% vs. 4.8%, 1.8%, P=0.001, P=0.001) and fewer lymph node metastasis (25.0% vs. 57.1%, 61.4%, P=0.001, P=0.001) than CM or CO approach. Survival analysis revealed a potential trend towards improved overall survival in RM approach compared with CM or CO approach (P=0.098, P=0.166).Conclusions: RM approach was a safe and efficient strategy in treating locally advanced resectable ESCC. Thereafter, nCT, a safe approach (3)(4)(5)(6) showing improved survival compared with surgery alone, is being applied as the standard approach for ESCC in the east.As is known to all, minimally invasive esophagectomy (MIE) had great advantages in improving short-term outcomes without compromised long-term survival (7)(8)(9). Recently, it is also demonstrated MIE is an acceptable surgical therapy for advanced-stage esophageal malignancies after nCRT (10-13). Nevertheless, the studies available included majorities of patients with adenocarcinoma located in the distal esophagus, which might be more favourable for MIE. As for locally advanced bulky ESCC, it is dangerous to resect as is mainly located in upper or middle-third of esophagus and closely adjacent to the tracheobronchial tree. The safety of MIE after neoadjuvant therapy in treating such patients has never been evaluated in a relative large sample size. Moreover, as patients with ESCC suffered from high incidence of postoperative mortality after nCRT, it is worthwhile to investigate whether MIE could lower the risk of mortality after neoadjuvant therapy, whether nCRT plus MIE (RM) approach could be rendered as a safe and efficient approach for locally advanced ESCC.This retrospective study was performed to compare outcomes in patients with locally advanced resectable ESCC undergoing RM, nCT plus MIE (CM) or [nCT plus open esophagectomy (OE)] (CO) approach and aims to illustrate the value of RM approach in treatment of locally advanced resectable ESCC. Methods PatientsBetween January 2010 to December 2016, patients completing neoadjuvant therapy followed by esophagectomy (n=194) were selected and their medical records were reviewed. The inclusion criteria were (I) thoracic ESCC; (II) McKeown or (III) Ivor-Lewi...

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Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma

Tsai

Crane

Skibber

et al. 2011

Cancer

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BACKGROUND Preoperative chemoradiation for rectal cancer can decrease the number of evaluable lymph nodes. Hence, the prognostic role of lymph node evaluation in patients with rectal cancer who receive preoperative chemoradiation is unclear. The authors of this report evaluated the prognostic impact of the number of lymph nodes examined in patients with rectal cancer who had negative lymph nodes based on the pathologic extent of disease (ypN0) after they received preoperative chemoradiation. METHODS Between 1990 and 2004, 372 patients with nonmetastatic rectal adenocarcinoma received preoperative chemoradiation followed by mesorectal excision and had ypN0 disease. The median radiation dose was 45 gray, and 68% of patients received adjuvant chemotherapy. RESULTS Patients had a median of 7 lymph nodes examined after preoperative chemoradiation. Compared with patients who had ≤7 lymph nodes examined, patients who had >7 lymph nodes had higher 5-year rates of freedom from relapse (86% vs 72%; log-rank P = .005) and cancer-specific survival (95% vs 86%; log-rank P = .0004), but no significant difference was observed in the overall survival rate (87% vs 81%; log-rank P = .07). Multivariate Cox proportional models demonstrated that patients who had >7 lymph nodes examined had a significantly lower risk of relapse (hazard ratio [HR], 0.39; P = .003) and death from rectal cancer (HR, 0.45; P = .04) but a similar risk of all-cause mortality (HR, 0.75; 95% CI, 0.46–1.20; P = .23) compared with patients who had ≤7 lymph nodes examined. CONCLUSIONS The number of lymph nodes examined was associated independently with disease relapse and cancer-specific survival in patients with rectal cancer who had ypN0 disease after receiving preoperative chemoradiation. Hence, the authors concluded that the number of negative lymph nodes examined may be a prognostic factor in patients with rectal cancer who receive preoperative chemoradiation.

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The Effect of Preoperative Chemoradiotherapy on Lymph Node Harvest After Total Mesorectal Excision for Rectal Cancer

Abstract: Preoperative chemoradiotherapy did not significantly decrease the overall number of lymph nodes retrieved but did increase the percentage of patients with fewer than 12 lymph nodes examined.

Cited by 20 publications

References 22 publications

Prognostic impact of the Lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation

Prognostic impact of the Lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma

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