Preoperative lateral lymph node features and impact on local recurrence after neoadjuvant chemoradiotherapy and total mesorectal excision for locally advanced rectal cancer: results from a multicentre international cohort study

Aim Locally advanced rectal cancer (LARC) is commonly treated with neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) to reduce local recurrence (LR) and improve survival. However, LR, particularly associated with lateral lymph node (LLN) involvement, remains a concern. The aim...

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Published in:	Colorectal disease Vol. 26; no. 3; pp. 466 - 475
Main Authors:	Achilli, Pietro, Ferrari, Davide, Calini, Giacomo, Bertoglio, Camillo L., Magistro, Carmelo, Origi, Matteo, Carnevali, Pietro, Alampi, Bruno D., Giusti, Irene, Ferrari, Giovanni, Calafiore, Eleonora, Spinelli, Antonino, Grass, Fabian, Deslarzes, Philip, Hahnloser, Dieter, Abdalla, Solafah, Larson, David W.
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-03-2024
Subjects:	Chemoradiotherapy Colorectal cancer lateral pelvic lymph nodes local recurrence Lymph nodes Lymphatic system Magnetic resonance imaging MRI rectal cancer Rectum Risk factors Surgery Survival total neoadjuvant therapy total neoadjuvant therapy lateral pelvic lymph nodes local recurrence MRI rectal cancer
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Summary:	Aim Locally advanced rectal cancer (LARC) is commonly treated with neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) to reduce local recurrence (LR) and improve survival. However, LR, particularly associated with lateral lymph node (LLN) involvement, remains a concern. The aim of this study was to investigate preoperative factors associated with LLN involvement and their impact on LR rates in LARC patients undergoing nCRT and curative surgery. Method This multicentre retrospective study, including four academic high‐volume institutions, involved 301 consecutive adult LARC patients treated with nCRT and curative surgery between January 2014 and December 2019 who did not undergo lateral lymph node dissection (LLND). Baseline and restaging pelvic MRIs were evaluated for suspicious LLNs based on institutional criteria. Patients were divided into two groups: cLLN+ (positive nodes) and cLLN– (no suspicious nodes). Primary outcome measures were LR and lateral local recurrence (LLR) rates at 3 years. Results Among the cohort, 15.9% had suspicious LLNs on baseline MRI, and 9.3% had abnormal LLNs on restaging MRI. At 3 years, LR and LLR rates were 4.0% and 1.0%, respectively. Ten out of 12 (83.3%) patients with LR showed no suspicious LLNs at the baseline MRI. Abnormal LLNs on MRI were not independent risk factors for LR, distant recurrence or disease‐free survival. Conclusion Abnormal LLNs on baseline and restaging MRI assessment did not impact LR and LLR rates in this cohort of patients with LARC submitted to nCRT and curative TME surgery.
Bibliography:	Davide Ferrari and Giacomo Calini contributed equally to this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1462-8910 1463-1318
DOI:	10.1111/codi.16875