Prognostic Implications of Nodal Yield in Rectal Cancer After Neoadjuvant Therapy: Is Nodal Yield Still Relevant Post Neoadjuvant Therapy?

Autor: Mira Sudam Wagh, V. M. Bharath, Preethi Sarah George, Arun Peter Mathew, Madhu Muralee, S. Renu, Faheem Ahmed Abdulla, K. Chandramohan
Rok vydání: 2021
Předmět:
Zdroj: Indian Journal of Surgery. 84:954-960
ISSN: 0973-9793
0972-2068
DOI: 10.1007/s12262-021-03154-w
Popis: Lymph node yield is an important factor to ensure adequate staging in rectal cancer. In rectal cancer after neoadjuvant treatment, the nodal yield decreases. However, many studies showed better outcomes for those patients with lesser nodal yield. This is a retrospective study from a prospectively maintained database, assessing factors affecting nodal yield in rectal cancer after neoadjuvant therapy and its prognostic implications with regard to disease recurrence. Patients who underwent curative resection of rectal cancer after neoadjuvant therapy from 2016 to 2018 were included. Nodal yield was calculated, and relevant clinical factors were collected and analysed. Patients were then followed up for assessing oncological outcomes. A total of 501 consecutive patients were included in the study period of 3 years. 87.9% of patients had pre-op neoadjuvant chemoradiation (NACRT). Mean nodal yield was 12.3 nodes with a range of 5–42. On multivariate analysis, nodal yield significantly increased with increasing pathological stage (p = 0.002) and positive lymphovascular invasion (p = 0.021). After a median follow-up of 24 months, disease-free survival probability at 3 years was 84.1% for those with less than or equal to 12 nodes vs 83% for more than12 nodes (p = 0.253). This trend was more so among those who attained pathological complete response (pCR) (96.1% vs 92.9%; p = 0.677). Presence of lymphovascular invasion significantly increases nodal yield. Pathological complete response was significantly associated with lesser nodal yield. Thereby, lesser nodes harvested after surgery may be a surrogate marker of better responses to radiation and thereby may indicate a better prognosis.
Databáze: OpenAIRE
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