Outcomes of Surgery Alone for Lower Rectal Cancer With and Without Pelvic Sidewall Dissection

Kobayashi, Hirotoshi; Mochizuki, Hidetaka; Kato, Tomoyuki; Mori, Takeo; Kameoka, Shingo; Shirouzu, Kazuo; Sugihara, Kenichi

doi:10.1007/dcr.0b013e3181a1d994

Cited by 149 publications

(98 citation statements)

References 21 publications

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“…The incidence of LPLN-positive status (18.3%) in our study was similar to that of pathological LPLN metastasis of previous reports, in which patients underwent surgery alone (1)(2)(3)(4)(5). Following preoperative CRT, 7 of the 19 (36.8%) initially LPLN-positive patients exhibited LPLN downsizing to <7 mm; none of these 7 patients developed recurrence.…”

Section: Discussionsupporting

confidence: 88%

“…LPLN dissection is often performed with TME in advanced low RC in Japan, as TME does not remove LPLN, which may contain metastasis and lead to local recurrence. The incidence of LPLN metastasis is reportedly 10-20% in patients with advanced low RC who undergo LPLN dissection (1)(2)(3)(4)(5). Although a retrospective analysis has suggested that LPLN dissection is equivalent to preoperative CRT in terms of local control for patients with lower RC (6), the effect of preoperative CRT on patients with involved LPLN has not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

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Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

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Abstract. Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Inoue

Saigusa

Hiro

et al. 2016

Molecular and Clinical Oncology

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“…In Japan, on the contrary, lateral pelvic LN dissection has been done extensively along with TME in advanced rectal cancer, which contributed to the reduced local recurrence and improved survival in retrospective multicenter studies (19). A retrospective analysis suggests that lateral pelvic LN dissection can be equivalent to the preoperative radiotherapy in terms of the curative effect for patients with lower rectal cancers (20).…”

Section: Rectal Cancermentioning

confidence: 99%

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

Kawada

Taketo²

2011

Cancer Research

142

114

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The effect of local therapy, such as surgical lymph node (LN) dissection and radiotherapy, on the survival of cancer patients has been debated for decades. Several lines of recent clinical evidence support that LN metastasis plays significant roles in systemic dissemination of cancer cells, although the effects of surgical LN dissection on survival was downplayed historically because of controversial data. Molecular studies of LN metastasis suggest that the microenvironment within LNs, including chemokines and lymphangiogenesis, can mediate the metastatic spread to the sentinel LNs, and beyond. It has been shown that chemokine receptor CXCR3 is involved in LN metastasis, and its inhibition may improve patient prognosis. Although it remains to be determined whether local therapy is best pursued through LN dissection or through a combination of resection with radiation, prevention of regional metastases is an important goal in the treatment of cancer patients to achieve a better survival. Cancer Res; 71(4); 1214-8. Ó2011 AACR.

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“…Однако доказательной базы о преимущест-вах аортоподвздошно-тазовой лимфодиссекции нет. Например, в ретроспективном анализе, включавшем 1272 больных, которым была выполнена ТМЭ по поводу нижнеампулярного рака прямой кишки в 12 институтах Японии с 1991 по 1998 г., не было существенной разницы между пациентами с и без латеральной диссекции по частоте местных рециди-вов и 5-летней ОВ (75,8 и 79,5 % соответственно) [26]. В рандомизированном исследовании, проведенном на базе основных 33 госпиталей Японии, сравнили непосредственные результаты лечения при выполне-нии ТМЭ с тазовой лимфодиссекцией (n = 352) и без (n = 350), набор пациентов осуществлялся с 2003 по 2010 г.…”

Section: анатомическое определениеunclassified

Selection of surgical approach and role of lymph node dissection at colorectal cancer

Мельников¹,

Савенков²

2015

Onkol. koloproktol.

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Outcomes of Surgery Alone for Lower Rectal Cancer With and Without Pelvic Sidewall Dissection

Abstract: Although pelvic sidewall dissection does not appear to confer overall benefits regarding local recurrence or survival, the effectiveness of pelvic sidewall dissection in specific patient groups remains uncertain. A randomized controlled study is necessary to clarify this issue.

Cited by 149 publications

References 21 publications

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

Selection of surgical approach and role of lymph node dissection at colorectal cancer

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