MRI before CRT is useful to predict LPLN metastasis and to determine the indications for LPLD.

BackgroundThe impact of body composition on the short- or long-term outcomes of patients with surgically treated advanced rectal cancer after neoadjuvant chemoradiotherapy remains unclear. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer.MethodsWe enrolled 144 clinical stage II/III patients with advanced lower rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative resection between 2004 and 2011. The cross-sectional skeletal muscle area at the third lumbar vertebra (L3) level was evaluated by computed tomography before chemoradiotherapy, and this was normalized by the square of the height to obtain the skeletal muscle index. Low skeletal muscle mass was defined as the sex-specific lowest quartile of the L3 skeletal muscle index. The association between low skeletal muscle mass and morbidity, relapse-free survival, or overall survival was assessed.ResultsLow skeletal muscle mass was identified in 37 (25.7%) patients. Age and body mass index were associated with low skeletal muscle mass. By multivariate analysis, we found that low skeletal muscle mass was independently associated with poor overall survival (hazard ratio = 2.93; 95%CI: 1.11–7.71; p = 0.031) and relapse-free survival (hazard ratio = 2.15; 95%CI: 1.06–4.21; p = 0.035), but was not associated with the rate of postoperative complications.ConclusionsLow skeletal muscle mass is an independent negative prognostic factor for relapse-free and overall survival in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy.

Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.

Background: The neutrophil-to-lymphocyte ratio (NLR) is considered an indicator of systemic inflammation and may predict prognosis in colorectal cancer. In this study, we examined the prognostic impact of NLR in patients with locally advanced low rectal cancer treated with neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Methods: From 2004 to 2012, we analyzed 201 consecutive patients with locally advanced low rectal cancer below the peritoneal reflection who underwent NACRT and curative resection. Blood samples were obtained before NACRT. NLRs were dichotomized using a cut-off value of 3.0, which was chosen based on receiver operating characteristic analysis and previous studies, and we analyzed their relationship with clinical outcomes. Results: Forty-four (21.9%) patients had a high NLR. Moreover, a high NLR was significantly associated with elevated carcinoembryonic antigen levels before NACRT (p = 0.0154). Multivariate analysis showed that a high NLR was independently associated with worse overall survival (hazard ratio (HR) 3.38, p = 0.012). In contrast, a high NLR was not significantly associated with relapse-free survival (HR 1.073, p = 0.8438). The post-recurrence survival between patients with high and low NLRs was significantly different (p = 0.0370). Conclusions: A high NLR (≥3.0) prior to NACRT was independently associated with poor prognosis in patients with locally advanced low rectal cancer treated with NACRT and radical resection.