Selective Lateral Pelvic Lymph Node Dissection in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy Based on Pretreatment Imaging

• Published in: Annals of surgical oncology Vol. 21; no. 1; pp. 189 - 196
• Main Authors: Akiyoshi, Takashi, Ueno, Masashi, Matsueda, Kiyoshi, Konishi, Tsuyoshi, Fujimoto, Yoshiya, Nagayama, Satoshi, Fukunaga, Yosuke, Unno, Toshiyuki, Kano, Atsuhiro, Kuroyanagi, Hiroya, Oya, Masatoshi, Yamaguchi, Toshiharu, Watanabe, Toshiaki, Muto, Tetsuichiro
• Format: Journal Article
• Language: English
• Published: Boston Springer US 2014; Springer Nature B.V
• Subjects: Adenocarcinoma, Mucinous - drug therapy; Adenocarcinoma, Mucinous - mortality; Adenocarcinoma, Mucinous - secondary; Adenocarcinoma, Mucinous - surgery; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Signet Ring Cell - drug therapy; Carcinoma, Signet Ring Cell - mortality; Carcinoma, Signet Ring Cell - secondary; Carcinoma, Signet Ring Cell - surgery; Chemoradiotherapy; Colorectal Cancer; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Oncology; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - mortality; Pelvic Neoplasms - pathology; Pelvic Neoplasms - surgery; Preoperative Care; Prognosis; Rectal Neoplasms - drug therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Surgery; Surgical Oncology; Survival Rate; Local Recurrence; Peritoneal Reflection; Total Mesorectal Excision; Lateral Pelvic Lymph Node; Lateral Pelvic Lymph Node Dissection
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-013-3216-y

Background
The significance of lateral pelvic lymph node (LPLN) metastasis in advanced low rectal cancer treated with preoperative chemoradiotherapy (CRT) remains unclear. The objective of this study was to evaluate the outcomes of selective LPLN dissection (LPLD) based on the pretreatment imaging in patients with advanced low rectal cancer treated with preoperative CRT.
Methods
We reviewed 127 consecutive patients with clinical stage II–III low rectal cancer below the peritoneal reflection who underwent preoperative CRT and curative resection. LPLD was performed in patients with suspected LPLN metastasis based on MDCT or MRI before CRT (LPLD group,
N
 = 38), and only total mesorectal excision (TME) was performed in patients without suspected LPLN metastasis (TME group,
N
 = 89). Clinical characteristics and the oncological outcome were compared between groups.
Results
The median tumor-to-anal verge distance was 40 mm in both groups. The median maximum long-axis LPLN diameter before CRT was 0 mm in the TME group and 10.5 mm in the LPLD group. Pathological LPLN metastasis was confirmed in 25 patients (66 %) in the LPLD group. Local recurrence at LPLN developed in 3 patients (3.4 %) in the TME group and in none (0 %) of the LPLD group. Multivariate analysis showed that only ypN was an independent prognostic factor for relapse-free survival (RFS), but LPLN metastasis was not associated with poor RFS.
Conclusions
The incidence of LPLN metastasis is high even after preoperative CRT, and LPLD might improve local control and survival of patients with LPLN metastasis in advanced low rectal cancer treated with preoperative CRT.