Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer
| Autor: | Jun Yu, Juan Li, Shi Wen Mei, Zheng Wang, Xi Shan Wang, Qian Liu, Jia Nan Chen, Zhi-Jie Wang, Zheng Liu, Wei Pei, Hai Yu Shen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer Lymphatic metastasis Observational Study Disease-Free Survival Metastasis 03 medical and health sciences 0302 clinical medicine Risk Factors Lateral lymph node dissection medicine Humans Stage (cooking) Locoregional recurrence Neoplasm Staging Retrospective Studies business.industry Rectal Neoplasms Neoadjuvant therapies Gastroenterology Retrospective cohort study General Medicine Odds ratio Chemoradiotherapy Adjuvant Middle Aged medicine.disease Total mesorectal excision Neoadjuvant Therapy Dissection 030220 oncology & carcinogenesis T-stage Lymph Node Excision 030211 gastroenterology & hepatology Female Radiology Lymph Nodes Neoplasm Recurrence Local business |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 2219-2840 1007-9327 |
| Popis: | Background Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer. Neoadjuvant chemoradiotherapy (NCRT) can effectively reduce the postoperative recurrence rate; thus, NCRT with total mesorectal excision (TME) is the most widely accepted standard of care for rectal cancer. The addition of lateral lymph node dissection (LLND) after NCRT remains a controversial topic. Aim To investigate the surgical outcomes of TME plus LLND, and the possible risk factors for lateral lymph node metastasis after NCRT. Methods This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018. In the NCRT group, TME plus LLND was performed in patients with short axis (SA) of the lateral lymph node greater than 5 mm. In the non-NCRT group, TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm. Data regarding patient demographics, clinical workup, surgical procedure, complications, and outcomes were collected. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients. Results LLN metastasis was pathologically confirmed in 35 patients (39.3%): 26 (41.3%) in the NCRT group and 9 (34.6%) in the non-NCRT group. The most common site of metastasis was around the obturator nerve (21/35) followed by the internal iliac artery region (12/35). In the NCRT patients, 46% of patients with SA of LLN greater than 7 mm were positive. The postoperative 30-d mortality rate was 0%. Two (2.2%) patients suffered from lateral local recurrence in the 2-year follow up. Multivariate analysis showed that cT4 stage (odds ratio [OR] = 5.124, 95% confidence interval [CI]: 1.419-18.508; P = 0.013), poor differentiation type (OR = 4.014, 95%CI: 1.038-15.520; P = 0.044), and SA ≥ 7 mm (OR = 7.539, 95%CI: 1.487-38.214; P = 0.015) were statistically significant risk factors associated with LLN metastasis. Conclusion NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter, poorer histological differentiation, or advanced T stage. Selective LLND for NCRT patients can have a favorable oncological outcome. |
| Databáze: | OpenAIRE |
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