Lateral lymph node dissection for mid-to-low rectal cancer: is it safe and effective in a practice-based cohort?

Abstract

Background Most evidence regarding lateral lymph node dissection for rectal cancer is from expert settings. This study aimed to evaluate the safety and efficacy of this procedure in a practice-based cohort. Methods A total of 383 patients who were diagnosed with stage II–III mid-to-low rectal cancer between 2010 and 2019 and underwent primary resection with curative intent at a general surgery unit were retrospectively reviewed. After propensity matching, 144 patients were divided into the following groups for short- and long-term outcome evaluation: mesorectal excision with lateral lymph node dissection (n = 72) and mesorectal excision (n = 72). Results This practice-based cohort was characterized by a high pT4 (41.6%) and R1 resection (10.4%) rate. Although the operative time was longer in the lateral dissection group (349 min vs. 237 min, p < 0.001), postoperative complications (19.4% vs. 16.7%, p = 0.829), and hospital stay (18 days vs. 22 days, p = 0.059) did not significantly differ; 5-year relapse-free survival (62.5% vs. 66.4%, p = 0.378), and cumulative local recurrence (9.7% vs. 15.3%, p = 0.451) were also in the same range in both groups. In the seven locally recurrent cases in the lateral dissection group, four had undergone R1 resection. Conclusions Lateral lymph node dissection was found to be safe in this practice-based cohort; however, the local control effect was not obvious. To maximize the potential merits of lateral lymph node dissection, strategies need to be urgently established to avoid R1 resection in clinical practice.

Prognostic Significance of Lateral Pelvic Lymph Node Dissection for Middle-Low Rectal Cancer Patients with Lateral Pelvic Lymph Node Metastasis: A Propensity Score Matching Study

“…A retrospective study involving 899 colorectal cancer patients at a high-volume cancer centre in Japan conducted by Wang et al revealed that even with LPND, patients with LPNM still showed an elevated risk of local recurrence (30.0% vs 10.0, P = 0.025) [12] . Similarly, Numata et al suggested that additional LPND based on TME cannot achieve obvious local control compared with TME alone (27.8% vs 26.4%, P = 1.000), while increasing the R0 resection rate is crucial to maximizing the potential merits of LPND [13] . The literature has shown that both chemotherapy and TME combined with LPND have the same long-term survival outcomes in rectal cancer patients with LPNM and that even the former can achieve a reduction in local recurrence [18] .…”

“…Several studies have demonstrated that LPNs are the most common site of postoperative recurrence [12,13,17] . In the present study, even after TME + LPND, the postoperative overall recurrence rate (51.7% vs 21.4%, P = 0.001) and local recurrence rate (27.6% vs 4.5%, P = 0.001) of patients with LPNM were signi cantly higher than those of patients without LPNM.…”

“…Several Japanese studies have suggested that the overall bene t related to local recurrence and survival of LPND is not promising in patients with LPNM [9][10][11][12][13] . Therefore, it is necessary to clarify the effectiveness of LPND with regard to increasing local control and prolonging survival.…”

The additional diagnostic impact of positron emission tomography–computed tomography for lymph node metastasis from colorectal cancer: A prospective lymph node level analysis

“…[2][3][4][5][6] The prophylactic manner of this procedure thus remains controversial, although therapeutic dissection has been considered necessary for patients' prognostic benefit. 3,[7][8][9] In addition, the effectiveness of prophylactic dissection for para-aortic lymph nodes has not been established, although some reports have suggested that selective dissection might benefit survival. 10,11 Therefore, to identify patients indicated for extraregional lymph node dissection, the accuracy of diagnosing lymph node metastasis in colorectal cancer patients must be improved.…”

Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis

“…In addition, the guidelines 2019 of the Japanese Society for Cancer of the Colon and Rectum recommend that TME + LPND should be performed if a preoperative or intraoperative diagnosis reveals the presence of LPNM [ 4 ]. However, recent literature has shown that, even with TME + LPND, patients with LPNM still show an increased risk of local recurrence and distant metastasis, resulting in a poor prognosis [ 5 , 6 ]. In contrast, neoadjuvant chemoradiotherapy (nCRT) followed by TME was mostly employed for locally advanced rectal cancer, and several relevant randomized control studies revealed that, compared with TME alone, nCRT followed by TME could reduce the local recurrence rate by approximately 10% in clinical II or III rectal cancer patients [ 7 , 8 ].…”