Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients

Kim, Tae Gyu; Park, Won; Choi, Doo Ho; Park, Hee Chul; Kim, Seok-Hyung; Cho, Yong Beom; Yun, Seong Hyeon; Kim, Hee Cheol; Lee, Woo Yong; Lee, Jeeyun; Park, Joon Oh; Park, Young Suk; Lim, Ho Yeong; Kang, Won Ki; Chun, Ho-Kyung

doi:10.1007/s00384-013-1797-3

Cited by 68 publications

(50 citation statements)

References 24 publications

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“…The remaining 21 studies were reviewed with full texts, among which two studies had unclear reporting of neoadjuvant therapy, one lacked endpoint data, and five lacked comparison between LNR groups. Finally, 13 studies with 4023 participants were included in the meta‐analysis, and all were published in recent years (from 2011 up to now). Table offers the baseline characteristics of all included studies.…”

Section: Resultsmentioning

confidence: 99%

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta‐analysis

Jin

Deng

et al. 2018

J Evidence Based Medicine

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Section: Resultsmentioning

confidence: 99%

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta‐analysis

Jin

Deng

et al. 2018

J Evidence Based Medicine

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“…Previous studies have documented high rates of lateral pelvic recurrence in patients with enlarged LLNs not treated by LLND after (C)RT. One study of 116 patients with ypN+ disease reported lateral pelvic recurrence rates of 35·7 and 87·5 per cent respectively when enlarged LLNs had a short‐axis diameter of 5–9·9 mm and 10 mm or more.…”

Section: Discussionmentioning

confidence: 96%

“…In contrast, in Western countries, neoadjuvant (C)RT protocols are mostly employed, resulting in local recurrence rates of less than 10 per cent, with minimal indication for LLND. Recently, however, Eastern and Western studies have suggested that (C)RT and TME without LLND may not be sufficient in patients with enlarged LLNs, with a lateral pelvic recurrence rate of 19·5 per cent in patients with LLNs 7 mm or more in size.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of residual lateral lymph node metastasis after neoadjuvant (chemo)radiotherapy in patients with advanced low rectal cancer

et al. 2019

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Background There is a lack of large studies focusing on the prognostic significance of lateral lymph node (LLN) metastasis following LLN dissection (LLND) in rectal cancer. The aim of this study was to evaluate the prognostic impact of LLN metastases on survival of patients with advanced low rectal cancer. Methods Consecutive patients with locally advanced, but not metastatic, extraperitoneal rectal cancer treated with neoadjuvant (chemo)radiotherapy plus total mesorectal excision between 2004 and 2015 were included in the study. LLND was performed when pretreatment imaging documented enlarged LLNs (7 mm or greater in size). Localization of nodal metastases and long‐term outcomes were analysed. Kaplan–Meier analysis was used to compare the survival of patients with ypN0 disease with that of patients with mesorectal ypN+/LLN− status and patients with positive LLNs. The Cox proportional hazards model was used to evaluate predictors of disease‐free survival (DFS) and local recurrence. Results A total of 613 patients were included in the study; LLND was performed in 212 patients (34·6 per cent) and 57 (9·3 per cent) had LLN metastasis. Patients with LLN metastasis had improved DFS and local recurrence cumulative incidence rates compared with patients with mesorectal ypN2+/LLN− disease (DFS: P = 0·014; local recurrence: P = 0·006). Although the DFS rate of patients with LLN metastasis was worse than that of patients with ypN0 disease (P < 0·001), the cumulative incidence of local recurrence was similar (P = 0·491). In multivariable analysis, residual LLN metastasis was not an independent predictor of worse DFS or local recurrence. Conclusion LLN metastasis is not an independent predictor of local recurrence or survival. Survival of patients presenting with LLN metastasis after (chemo)radiotherapy was intermediate between that of patients with ypN0 status and those with mesorectal ypN2 positivity.

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“…Several Korean centres (that do not perform LLND) have shown increased local recurrence rates in patients with enlarged lateral lymph nodes on preoperative staging treated with neoadjuvant (chemo)radiotherapy and TME, suggesting this may be insufficient for adequate disease control. A recent small UK series suggested similar trends, with a high lateral local recurrence rate in patients with a lymph node short axis larger than 10 mm.…”

Section: Introductionmentioning

confidence: 94%

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

Schaap

Ogura

Maas

et al. 2018

British Journal of Surgery

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Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients

Abstract: LPLN ≥ 2 and a ratio of the number of positive LN/number of dissected LN > 0.3 were prognostic of poor LPFS. The prediction curve of LPR according to the number and size of LPLN could be useful for determining the benefit of additional lateral pelvic treatment.

Cited by 68 publications

References 24 publications

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta‐analysis

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta‐analysis

Prognostic impact of residual lateral lymph node metastasis after neoadjuvant (chemo)radiotherapy in patients with advanced low rectal cancer

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

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