Local recurrence and occult neoplastic cells in the extranodal fat of dissected lymph nodes in patients with curatively resected primary colorectal cancer

Abstract

This study was designed to examine the relationship between occult neoplastic cells (ONCs) inside and outside harvested lymph nodes (intranodal/extranodal ONCs) and local recurrence in 30 patients who underwent curative resection of primary colorectal cancer. Among 10 patients with colon cancer (Dukes' A=1, Dukes' B=6 and Dukes' C=3), intranodal ONCs were positive in 1 patient (10.0%) and negative in 9 patients (90.0%), while extranodal ONCs were negative in all 10 patients (100.0%). There were no significant differences between the detection of intranodal or extranodal ONCs. Among 20 patients with rectal cancer (Dukes' A=4, Dukes' B=2 and Dukes' C=14), intranodal ONCs were positive in 5 (25.0%) and negative in 15 (75.0%), while extranodal ONCs were positive in 3 (15.0%) and negative in 17 (85.0%). There were no significant differences between the detection of intranodal or extranodal ONCs. These results suggest that patients with rectal cancer and extranodal ONCs should be followed-up carefully as a high-risk group for pelvic local recurrence. However, the prevalence of extranodal and intranodal ONCs was almost similar.

Pelvic local recurrence as first relapse predicts prognosis for clinical stage II/III lower rectal cancer: A clinicopathological investigation

“…These two reasons do not seem to add up at present (4)(5)(6)(7)(8)(9)(10)(11). An alternative approach could be to control fatal hematogenous metastasis in the lung and liver, which may be more beneficial than reducing local recurrence in extending progression-free and overall survival rates (3,18,19). However, in the present study, the prognosis of the remote metastasis group was better than that of the local recurrence group.…”

“…The prognosis following rectal cancer surgery is considerably poorer than after colon cancer, for the following possible reasons: i) The pelvic cavity narrows toward the anal region, making surgery difficult and pelvic local recurrence relatively common ( 3 ). ii) Preoperative chemoradiation and PBLND are conducted to lower the rate of recurrence and improve survival but, although these preoperative treatments significantly lower local recurrence rate, there is little evidence that they improve survival rate.…”

“…In men, a narrow pelvis makes it difficult to perform surgical procedures in the deep pelvic floor. In addition, the circumferential resection margin, anal margin and scattering of tumor cells due to perforation during rectal surgery are reported to influence pelvic local recurrence (3). To improve the survival rate by reducing local recurrence, integrated approaches for advanced rectal cancer, such as preoperative chemoradiation therapy and intrapelvic prophylactic bilateral lymph node dissection (PBLND) have been conducted (4)(5)(6)(7)(8)(9)(10)(11).…”

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

“…Invasion of adjacent organs, such as the prostate and the vagina is another problem for patients with Rb cancer located on the anterior wall of the lower rectum. Aside from consideration of prophylactic lateral lymph node dissection and laparoscopyassisted colorectal surgery, reports on local recurrence involving the pelvic floor or the anterior surface of the sacrum suggest that this is related to an inadequate resection and extranodal mesorectal spread, which are problems unique to the lower rectal cancer (17,18). Detection of such tumor spread is considered to be extremely difficult by macroscopic examination during surgery or even by pathological examination of intraoperative frozen sections for verification of the resection margin.…”

“…Therefore, it is most important to perform detailed examination of the surgical specimens from patients with Ra/ Rb cancer and lymph node involvement (e.g., by immunohistochemical staining of the mesorectum and surgical margins) and to identify patients with a high risk of recurrence in the early postoperative period (19,20). Patients in the high-risk group need stronger chemoradiotherapy as postoperative adjuvant therapy, additional radiotherapy for the pelvic floor or sacrum, and molecular-targeting agents combined with FOLFOX to control tumor growth (17)(18)(19)(20). Thus, treatment is clearly more complicated for patients with Ra/Rb cancer located deep in the pelvic floor than for patients with RS cancer.…”