Long-Term Outcome of Rectal Cancer With Clinically (EUS/MRI) Metastatic Mesorectal Lymph Nodes Treated by Neoadjuvant Chemoradiation: Role of Organ Preservation Strategies in Relation to Pathologic Response

Abstract

BackgroundOrgan preservation strategies are under investigation for patients with locally advanced rectal cancer (LARC) who achieve a complete pathologic response in the primary tumor (ypT0) after neoadjuvant chemoradiation therapy (CRT). This study explored the value of this approach for cN+ patients.MethodsData were retrieved from our institutional prospective rectal cancer database. Tumors with mesorectal lymph nodes larger than 5 mm shown on endorectal ultrasonography, pelvic magnetic resonance imaging, or both were staged as cN+.ResultsThe study population comprised 226 patients (142 men and 84 women; median age, 64 years) with LARC who underwent CRT followed by surgery including total mesorectal excision (TME) (n = 179) and full-thickness local excision (LE) (n = 47) between 1996 and 2013. At staging, 123 patients (54.4 %) were cN+. In 65 cases (28.7 %), ypCR was observed. Metastatic mesorectal lymph nodes (ypN+) were detected in 41.6 % of the cN+ patients and in 2.8 % of the cN0 patients (P < 0.01). Among the cN+ patients, 16 % of the ypT0 cases were ypN+ compared with 51.8 % of the no-ypT0 cases (P < 0.01). Among the cN+ patients who underwent TME, the 5-year disease-specific survival (DSS) and disease-free survival (DFS) rates were respectively 100 and 91.6 % for the ypT0 patients compared with 71.2 and 58.0 % for the no-ypT0 patients (P = 0.01). Among the ypN+ patients, the 5-year DSS and DFS rates were both 100 % for the ypT0 cases compared with 59.1 and 43.3 % for the no-ypT0 patients. Among the cN+ and ypT0 patients, the 5-year DSS and DFS were respectively 100 and 85.7 % for the TME patients compared with 100 and 91.6 % for the LE patients. In the multivariate analysis, ypT0 was the only independent prognostic factor.ConclusionsProtocols aimed at organ preservation in LARC that achieve ypT0 after CRT can be offered also to cN+ patients.

Endosonography Elastography and Magnetic Resonance Imaging in the Restaging and Response Assessment of Rectal Cancer After Neoadjuvant Therapy

“…The present study showed that the accuracy rates of ERUS and MRI for detecting metastatic lymph nodes were 44.4% and 66.7%, respectively, which is consistent with previous findings. 6,10 Belluco et al 11 found that in 42.2% of patients who underwent surgery after nCRT treatment found pathological metastatic lymph nodes. However, 16% of surgical specimens existed in the subgroup of patients with YPT0.…”

The role of rectal endoscopic ultrasonography plus fine needle aspirartion and fine needle biopsy in pelvic masses

“…Although several studies have evaluated the diagnostic yield of cross-sectional and functional nuclear imaging modalities, data on the role of EUS in rectal cancer follow-up are still lacking. With its tissue acquisition capability, EUS could be a reliable complementary technique in differentiating benign postoperative flogistic tissue from malignant local recurrence [13,14].…”

Long-term efficacy of transanal local excision versus total mesorectal excision after neoadjuvant treatment for rectal cancer: A meta-analysis

“…Characteristics of the included studies are shown in (Tables 1 and 2). Of all 13 studies, ten were CSs (including six propensity score matching analyses) [28][29][30][31][32][33][34][35][36][37], three were RCTs [38][39][40], ten CSs and three RCTs reported LR, four CSs reported LRFS, six CSs and two RCTs reported OS, six CSs and three RCTs reported DFS, two RCTs reported DSS. This study included 1402patients, of which 570 patients (40.66%) underwent TLE and 832 patients (59.34%) underwent TME.…”

“…All 10 CSs had a score of �7, indicating a low risk of bias. Among them, 9 CSs [28][29][30][32][33][34][35][36][37] were rated as having incomplete follow-up due to their failure to describe the attrition rate, while 3 studies [31,33,35] were…”