Lymph node yield in rectal cancer surgery: Effect of preoperative chemoradiotherapy

Morcos, Basem; Baker, Bilal; Masri, Mahmoud Al; Haddad, Hussam; Hashem, Sameh

doi:10.1016/j.ejso.2009.12.006

Cited by 90 publications

(62 citation statements)

References 26 publications

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“…The number of lymph nodes dissected from rectal specimens was found to be directly proportional to the probability of detecting disease in them [20]. Nevertheless, adequate sampling of lymph nodes decreases the incidence of local recurrences [21,22] and improves the patient overall survival [23,24].…”

Section: Discussionmentioning

confidence: 99%

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Elsheikh¹,

M²

2016

J Adenocarcinoma

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Introduction: Total lymph node (TLN) count is an important qualifier of cancer evaluation and extensive nodal resection has been associated with lower rates of cancer recurrence; allows for more accurate cancer staging and improved survival following resection for rectal cancer. Aim:To examine the adequacy of lymph node sampling in rectal cancer and the influence of the clinicopathological factors and treatment modalities on the total lymph node yield.Methods: This is a retrospective study includes 409 cases of rectal cancer treated by surgical intervention only (126 cases), or surgery after short or long course chemotherapy (75 and 208 cases respectively).Results: TLN count range from (2-50, mean 12.38). Twelve lymph nodes were found in 49.4% of the specimens with or without neoadjuvent chemo radiatherapy (CRT). Patient treated with surgery only have a significant high total LN yield (mean is 15.53) in comparison with (12.99 and 10.25 for short course CRT and long course CRT respectively, P value <0.001). The number of lymph nodes was significantly correlated with the modality of treatment, anterior quadrant involvement, vascular and perineural invasion, pathological staging, Duke's and Mandard staging. On multivariate only perineural invasion, high tie lymph node involvement, Dukes stage, and tumour load were found to be the main predictors of the number of lymph node yield. Conclusion:The neoadjuvent CRT has a significant effect on the adequacy of lymph node sampling and a negative impact on the lymph nodes retrieved. This negative effect was more prominent with the long term rather than the short term CRT. This should be taken in consideration at the N staging of the tumour to avoid down-staging.

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Section: Discussionmentioning

confidence: 99%

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Elsheikh¹,

M²

2016

J Adenocarcinoma

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“…Furthermore, while a correlation between lymph node metastasis and poor oncologic outcome in patients treated with PCRT and radical resection has been suggested, the value of the LNR after PCRT remains controversial [14,15] . PCRT has been shown to result in a significant decrease in both the size and number of LNs available for examination after resection [16][17][18][19][20] . Consequently, the number of LNs examined could be below the recommended number in patients with rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Park¹,

Yu²,

Lim³

et al. 2015

WJG

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AIM:To evaluate the predictive value of the lymph node (LN) ratio (LNR, number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy (PCRT). The cut-off LNR was determined based on the pN1 vs pN2 when the recommended number of LNs was harvested. The 5-year recurrence-free survival (RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group. METHODS: RESULTS:Among patients with the same p/ypN stage, the 5-year RFS rate differed according to the LNR. In addition, the 5-year RFS rate was significantly different between pN and LNR groups in patients with No PCRT. In PCRT group, however, only LNR was associated with prognosis. On multivariate analysis, both pN and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group. In the PCRT group, only LNR category was found to be associated with RFS (HR = 2.36, 95%CI: 1.31-3.84, and P = 0.001). CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT. Current pN categories could not discriminate between prognostic groups of RFS after PCRT. Core tip: The number of metastatic lymph node might show different prognosis according to the number of examined lymph node. Retrieved number of lymph node after preoperative chemoradiotherapy (PCRT) has been known fewer than those without PCRT. However, number of metastatic lymph nodes used in pathologic staging was same between patients treated with PCRT and those without PCRT. The present study suggests the metastatic lymph node ratio would be useful prognostic indicator and it is more prominent in patients treated with PCRT.Park IJ, Yu CS, Lim SB, Yoon YS, Kim CW, Kim TW, Kim JH, Kim JC. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy.

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“…Especially in rectal cancer adequate retrieval of lymph nodes may be troublesome as it is dependent on many factors such as age over 60, obesity, female sex, small tumour size and localisation, poor differentiation grade, the absence of a lymphoid reaction and neo-adjuvant therapy (27)(28)(29). The aim of this study is to assess the prognostic capacity of the metastatic lymph node ratio in stage III rectal cancer in addition to the 7 th edition of the TNM classification and to identify high risk patients.…”

Section: Introductionmentioning

confidence: 99%

Metastatic lymph node ratio in stage III rectal cancer; prognostic significance in addition to the 7th edition of the TNM classification

Dekker¹,

Peeters²,

Putter³

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Aims: Optimal staging in rectal cancer is indispensable for the decision on further treatment and estimation of prognosis. This study assesses the prognostic capacity of the metastatic lymph node ratio (LNR) in addition to the new TNM classification.Methods: LNR was determined, in stage III patients from the Dutch TME trial. Six year median follow up data from the trial database were used to analyse the relation of LNR to overall survival (OS) and local recurrence (LR). The relation of LNR to lymph node yield was assessed and appropriate cut off values of LNR for clinical use were determined.Results: 605 patients were analyzed. 278 underwent preoperative radiotherapy.82 patients developed a local recurrence and 289 distant metastases. LNR was an independent risk factor for OS, hazard ratio (HR) 2.10 (95%CI 1.35-3.27) (in addition to age >= 65 years, involved circumferential resection margin (CRM) and new TNM stage) and LR, HR 2.25 (95%CI 1.02-4.56) (in addition to pre operative radiotherapy and involved CRM). LNR is predictive of OS and LR from a lymph node yield of more than one and more than five respectively. A LNR value of 0.60 offers the best cut off to identify high risk patients (5 years OS was 61 vs. 32%, HR 2.45 (95% CI 1.96-3.08) and 5-years LR rate 12.6 versus 16.3%, HR 1.65 (95% CI 1.03-2.64)). 3Conclusions: LNR is an independent risk factor for OS and LR in addition to the 7th edition of the TNM classification. It can aid in predicting prognosis and identifying patients that should be considered for adjuvant treatment.

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Lymph node yield in rectal cancer surgery: Effect of preoperative chemoradiotherapy

Cited by 90 publications

References 26 publications

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Metastatic lymph node ratio in stage III rectal cancer; prognostic significance in addition to the 7th edition of the TNM classification

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