Neoadjuvant Chemoradiation for Rectal Cancer Reduces Lymph Node Harvest in Proctectomy Specimens

Fuente, Sebastián G. de la; Manson, Roberto J.; Ludwig, Kirk; Mantyh, Christopher R.

doi:10.1007/s11605-008-0717-2

Cited by 61 publications

(47 citation statements)

References 23 publications

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“…Even though it has been shown that there is an association between neo-adjuvant treatment and reduced LNY [15,16], we found a significant association between increasing LNY and the probability of detecting N-positive disease up to an LNY of 12-17, irrespective of neo-adjuvant treatment. This result indicates that an LNY of at least 12 LNs is needed to ensure N-negative disease, irrespective of neo-adjuvant treatment, which is in accordance with the abovementioned guidelines.…”

Section: Discussioncontrasting

confidence: 95%

“…Of these, 2123 (31.2 %) had received neo-adjuvant treatment. The median LNY was 13 (interquartile range (IQR) [8][9][10][11][12][13][14][15][16][17][18][19]. In the −neo-adjuvant treatment group compared to the +neo-adjuvant treatment group, there were median LNYs of 15 (IQR 10-22) and 10 (IQR 6-15), respectively, (p<0.0001), (Table 1).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…For rectal cancer patients who have received neo-adjuvant treatment, it has been demonstrated that the LNY, as well as the number of metastatic LNs, is significantly below the number observed in rectal cancer patients who have not received neo-adjuvant treatment and it has been questioned whether a minimum LNY of 12 is needed to ensure node negativity [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

Lykke

Jess

Roikjær

2015

Int J Colorectal Dis

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Section: Discussioncontrasting

confidence: 95%

Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

Lykke

Jess

Roikjær

2015

Int J Colorectal Dis

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“…This signifies that the tumor grade may predict the response to treatment (Table 2). In 8.3% of our patients there were lymph nodes retrieved in the specimen after surgical resection, this correlates well with the series reported by De laFuente SG et al 20 , who found fewer total lymph-nodes were retrieved in the neoadjuvant therapy patients compared to those who did not receive preoperatively therapy (Neo 14.6 +/-0.6 vs. No-Neo 17.2 +/-1.1).…”

Section: Discussionsupporting

confidence: 92%

Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan

2017

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Background: Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. Patients and methods: A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed. Preoperative pelvic radiotherapy was delivered. Total of 46 Gray were delivered concurrently with 5-fluorouracil (5-FU) on the first and last week of radiation. Total mesorectal excision of the rectal tumour either by anterior or abdominoperineal resections was planned at 6-8 weeks from completion of preoperative treatment. The pathological response to therapy was assessed by histopathology examination of the surgical specimen. Results: Initial clinical staging of patients revealed 58.3% of them were stage T3/T4N2M0 and 41.7% were stage T3N0M0. Down-staging to stage T1/T2N0M0 was found in 36.1% and stage T3N0M0 in 30.6%. No response was seen in 8.3% of cases with stage T3/T4N2M0 while complete clinical response (no residual) was seen in 25.0%. Complete histological response was observed in 13.8%. Positive lymph-nodes metastasis was confirmed in 8.3% of cases. Conclusion: Neoadjuvant chemoradiation is a reasonable option for cases of rectal cancer and deserves further evaluation.

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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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Neoadjuvant Chemoradiation for Rectal Cancer Reduces Lymph Node Harvest in Proctectomy Specimens

Cited by 61 publications

References 23 publications

A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan

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

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