Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer

Sugihara, Kenichi; Kobayashi, Hirotoshi; Kato, Tomoyuki; Mori, Takeo; Mochizuki, Hidetaka; Kameoka, Shingo; Shirouzu, Kazuo; Muto, Tetsuichiro

doi:10.1007/s10350-006-0714-z

Cited by 391 publications

(304 citation statements)

References 38 publications

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“…The incidence of LPLN-positive status (18.3%) in our study was similar to that of pathological LPLN metastasis of previous reports, in which patients underwent surgery alone (1)(2)(3)(4)(5). Following preoperative CRT, 7 of the 19 (36.8%) initially LPLN-positive patients exhibited LPLN downsizing to <7 mm; none of these 7 patients developed recurrence.…”

Section: Discussionsupporting

confidence: 88%

“…Multivariate analysis are ~45% (2,3,16,17), which are inferior to that of our patients with enlarged LPLN after CRT who had TME alone. Although the survival rates of the present study cannot be compared to previously reported rates, a proportion of patients with LPLN metastasis may clearly be treated by CRT-TME alone.…”

Section: Univariate Analysiscontrasting

confidence: 77%

“…LPLN dissection is often performed with TME in advanced low RC in Japan, as TME does not remove LPLN, which may contain metastasis and lead to local recurrence. The incidence of LPLN metastasis is reportedly 10-20% in patients with advanced low RC who undergo LPLN dissection (1)(2)(3)(4)(5). Although a retrospective analysis has suggested that LPLN dissection is equivalent to preoperative CRT in terms of local control for patients with lower RC (6), the effect of preoperative CRT on patients with involved LPLN has not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

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Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

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Abstract. Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy.

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Section: Discussionsupporting

confidence: 88%

Section: Univariate Analysiscontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

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“…It was reported that local recurrence can be found in 4%-50% of patients with rectal carcinoma after curative resection, and lateral lymph node metastasis may be the important factor for local recurrence [15,16] . Ueno et al [15] reported that patients with lateral node metastases have an increased risk for local recurrence (44% vs 11.7%; P < 0.001) compared with those without lateral node metastases.…”

Section: Discussionmentioning

confidence: 99%

“…The survival of patients with advanced low rectal cancer www.wjgnet.com still remains poor. It was reported that lateral lymph node metastasis may be the most important factor for local recurrence and poor prognosis of advanced low rectal cancer [15][16][17][18] . In the current study, the data on 96 consecutive patients who underwent curative surgery with total mesorectal excision and lateral lymph node dissection for advanced low rectal cancer at the Department of General Surgery of Guangdong Provincial People's Hospital were retrospectively analyzed.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

Wu¹,

Wan²,

Li³

et al. 2007

WJG

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AIM:To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHOD S :A t o t a l o f 9 6 c o n s e c u t i v e p a t i e n t s who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS:Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (χ 2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ 2 = 27.944, P = 0.0001).The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ 2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (χ 2 = 22.308, P = 0.0001).Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95%CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION:Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

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Comparison of the guidelines for colorectal cancer in Japan, the USA and Europe

Shinagawa

Tanaka

Nozawa

et al. 2017

Annals of Gastroent Surgery

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Colorectal cancer (CRC) is one of the most common cancers globally as well as in Japan and has shown a pattern of increasing incidence and mortality rates. Therefore, guidelines for CRC are considered to be crucial for establishing standard medical treatment not only in Japan but also around the world. In this article, we explain the features of the representative guidelines in Japan (Japanese Society for Cancer of the Colon and Rectum [JSCCR]), the USA (National Comprehensive Cancer Network [NCCN]) and Europe (European Society for Medical Oncology [ESMO]) and review the differences among these guidelines for CRC. We focus, in particular, on the descriptions of local treatments, including endoscopic treatment for CRC and transanal excision for lower rectal cancer; surgical treatments with lymph node dissection, including management of lower rectal cancer with lateral lymph node metastasis and laparoscopic surgery; and chemotherapy. Although the guidelines share basic principles, some details are different. Consulting the guidelines of various regions from around the world may aid in more precise and effective examination of the details and backgrounds of our own native guidelines.

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Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer

Abstract: Positive lateral lymph node was the strongest predictor in both survival and local recurrence. Pelvic sidewall dissection may be indicated for patients with T3-T4 lower rectal cancers because of the greater probability of positive lateral lymph nodes.

Cited by 391 publications

References 38 publications

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

Comparison of the guidelines for colorectal cancer in Japan, the USA and Europe

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