Effective dissection for rectal cancer with lateral lymph node metastasis based on prognostic factors and recurrence type

Abstract

Purpose There are no reports showing the significance and effective range of dissection for patients with lateral lymph node metastasis (LLNM). This study aimed to investigate the indications for lateral lymph node dissection (LLND) in patients with LLNM based on prognostic factors and recurrence types. Methods We reviewed 379 patients with advanced rectal cancer who were treated with total mesorectal excision plus LLND. We analyzed background factors and survival times of patients who had LLNM to determine prognostic factors and recurrence types. Results Pathological LLNM occurred in 44 (11.6%). Among patients with LLNM, the predictors of poor prognoses, according to univariate analysis, were > 3 node metastases, the presence of node metastasis on both sides, and spreading beyond the internal iliac lymph nodes. Moreover, LLNM beyond the internal iliac region was found to be an independent prognostic risk factor. Twenty-eight of the 44 patients with lateral lymph node metastasis (64%) relapsed, 22 of whom had distant metastases and 11 of whom experienced local recurrences. Among the latter group, nine (20%) and two (5%) had recurrences in the central and lateral pelvis, respectively. Conclusion The therapeutic benefit of resection was high, especially in patients with ≤ 3 positive lateral lymph nodes, one-sided bilateral lymph node areas, and positive nodes localized near the internal iliac artery.

Management of inguinal lymph node metastases from rectal and anal canal adenocarcinoma

“…The incidence of ILN metastasis from rectal and anal canal adenocarcinoma is 2.0%-4.5% [10,11] The results mentioned above might be attributed to the fewer haematogenous recurrences in our patients with ILN metastasis than in those with lateral LN metastasis in previous studies [25,28,32].…”

“…However, patients with ILN metastases from anorectal carcinoma were considered to have no worse a prognosis than patients with positive lateral LN metastasis, based on reports that showed a 5‐year overall survival rate of 25%–40% in patients with low rectal carcinoma showing lateral spread [27–31]. The results mentioned above might be attributed to the fewer haematogenous recurrences in our patients with ILN metastasis than in those with lateral LN metastasis in previous studies [25, 28, 32]. Moreover, ILN metastasis may be a more local disease than lateral LN metastasis.…”

“…Previous reports also showed that the prognosis of cases with ILN metastasis is poor [4, 13]. Compared to patients with lateral LN metastasis who underwent lateral LN dissection, which was often performed for low rectal carcinoma in previous studies [25, 26], overall and ILN recurrence rates after ILN dissection in cases of ILN metastasis are worse than overall and lateral LN recurrence rates, respectively, after lateral LN dissection in cases of lateral LN metastasis. However, patients with ILN metastases from anorectal carcinoma were considered to have no worse a prognosis than patients with positive lateral LN metastasis, based on reports that showed a 5‐year overall survival rate of 25%–40% in patients with low rectal carcinoma showing lateral spread [27–31].…”

Effective dissecting range and prognostic significance of lateral pelvic lymph node dissection for middle-low rectal cancer patients with lateral pelvic lymph node metastasis: Results of a large multicenter lateral node collaborative group in China

“…The survival benefits of LPND for patients with LPN metastasis depend on whether the local metastases can be cured by resection or if there is distant metastases that cannot be controlled locally. Previous studies confirmed that the location (5,13,21) and the number of LPN metastases (19,(22)(23)(24) are factors that affect the efficacy of LPND in patients with LPN metastases. In the present study, multivariate analysis demonstrated that lymph node metastasis to the common iliac or external iliac artery was an independent adverse prognostic factor for patients with LPN metastasis, with low 3-year OS and RFS rates.…”

“…Kanemitsu et al conducted a retrospective study involving 1,191 patients from two high-volume centers in Japan, and the results showed that the survival benefits from LPND of the internal iliac and obturator areas were comparable to those obtained through dissection of the superior rectal artery area (13). Similarly, Morohashi et al reported that lymph node metastasis outside the internal iliac and obturator lymph node area was an independent prognostic risk factor for patients with LPN metastasis (HR: 2.70; 95% CI, 1.20-6.08; P = 0.016) (21). The above literature is consistent with our study results, suggesting that external iliac or common iliac lymph node metastasis could be regarded as a systemic disease and that prognosis cannot improve even with dissection But that leads to increased urinary and sexual dysfunction; thus, the systemic comprehensive therapy should be strengthened to replace LPND.…”