Is prophylactic lateral lymph node dissection needed for lower rectal cancer? A single-center retrospective study

Abstract

Background The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer. Methods Data of 301 patients with lower rectal cancer (tumor’s lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups. Results Significantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups. Conclusions In this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.

A call for standardized reporting of early-onset colorectal peritoneal metastases

“…Forty-nine papers were excluded from the review for age-related reasons: six studies had 0–3 patients under age 50. Forty-three studies included patients under age 50 but did not present results stratified by age or did not stratify using an age ≤50 years old for stratification; one study provided above/below-age data but failed to include symbols (≥ or ≤) or descriptive text to indicate which group included the cutoff age (Sternberg et al , 1994; Nakae et al , 1995; Nakamura et al , 1999; Akasu et al , 2000; el-Ghazawy et al , 2001; Luna-Pérez et al , 2002; Al-Shamsi et al , 2003; Kanemitsu et al , 2003; Carmignani et al , 2004; Lloyd et al , 2006; Nervi et al , 2006; Lawson et al , 2008; Sobhani et al , 2008; Song et al , 2009; Aghili et al , 2010; Lemmens et al , 2011; Sjo et al , 2011; Lieu et al ., 2014; Park et al , 2014; Saluja et al , 2014; Adachi et al , 2015; Lam et al , 2015; Sica et al , 2015; Simkens et al , 2015; 2016; Maillet et al , 2016; Wang et al , 2016; Cicero et al , 2017; Hojo et al , 2017; Patil et al , 2017; Cigdem Arslan et al , 2018; Kondo et al , 2021; Melli et al , 2021; Rieser et al , 2021a, 2021b; Sharma et al , 2021; Tabchouri et al , 2021; Yang et al , 2021; Zhou et al , 2021; Flood et al , 2022; Iwasaki et al , 2022; McCleary et al , 2022; Meyer et al , 2022; Nagao et al , 2022).…”