Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial

Fujita, Shin; Aoki, Takayuki; Mizusawa, Junki; Saitô, Norio; Kinugasa, Yusuke; Kanemitsu, Yukihide; Ohue, Masayuki; Fujii, Satoshi; Shiozawa, Manabu; Yamaguchi, Takashi; Moriya, Yoshihiro

doi:10.1016/s1470-2045(12)70158-4

Cited by 314 publications

(253 citation statements)

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“…In Japan, lateral pelvic lymph node involvement is considered as loco-regional disease, and in West, it is regarded as systemic disease [49][50][51] . Thus, present strategies for the management of lateral pelvic lymph node are TME with neo-adjuvant chemo-radiotherapy and/or lateral pelvic lymph node dissection [47,[52][53][54] . The recent study suggested that patients with lateral pelvic lymph nodes responsive to neoadjuvant chemo-radiotherapy may not benefit from lateral pelvic lymph node dissection and subgroup with persistent lateral pelvic lymph node following neo-adjuvant chemo-radiotherapy may benefit from lateral pelvic lymph node dissection [8] .…”

Section: Lateral Pelvic Lymph Node Dissectionmentioning

confidence: 99%

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

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Section: Lateral Pelvic Lymph Node Dissectionmentioning

confidence: 99%

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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“…Причина их связана с расширением объема опе-рации, более выраженной интраоперационной крово-потерей и нарушением функции тазовых органов [27].…”

Section: Discussionunclassified

Tactics Sphincter Sparing Surgery in Locally-Advanced Rectal Ultra-Low Localisation With a Lesion of the Lateral Group Lymph Nodes: Clinical Cases

Тамразов¹,

Барсуков²,

Nikolaev³

et al. 2016

Onkol. koloproktol.

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“…1,2 The divergent philosophy in the approach to curative management of pelvic micrometastases was most recently highlighted by the JCOG 0212 trial, which evaluated the noninferiority of TME alone to TME with routine prophylactic lateral pelvic lymph node dissection (LPLND) among patients without clinical evidence of lateral pelvic lymph node metastasis. 3 In this study, no patients received radiotherapy and the experimental treatment strategy of TME alone was inferior to the control strategy of TME ? LPLND for local control.…”

mentioning

confidence: 81%

Selective Lateral Pelvic Lymph Dissection for Rectal Cancer

Chang

2017

Ann Surg Oncol

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While the approach to curative treatment of low rectal cancer in the West has included preoperative radiation therapy (RT) followed by total mesorectal excision (TME), in Japan the ''gold standard'' traditionally has been TME with prophylactic dissection of the iliac and obturator lymph nodes without pelvic radiotherapy.1,2 The divergent philosophy in the approach to curative management of pelvic micrometastases was most recently highlighted by the JCOG 0212 trial, which evaluated the noninferiority of TME alone to TME with routine prophylactic lateral pelvic lymph node dissection (LPLND) among patients without clinical evidence of lateral pelvic lymph node metastasis.3 In this study, no patients received radiotherapy and the experimental treatment strategy of TME alone was inferior to the control strategy of TME ? LPLND for local control. JCOG 0212 also demonstrated that lateral pelvic lymph node metastases occurred in 7% of patients who were radiographically nodenegative within the lateral compartment before surgery and that the addition of LPLND resulted in a 5.2% absolute reduction in the rate of local failure. 4 While in the experienced hands of the JCOG 0212 investigators and in Japanese patients, the addition of LPLND had a limited effect on the overall rate of postoperative complications (22% vs. 16% grade 3-4 for TME ? LPLND vs. TME alone, respectively), it did add significantly to the length of operation and to total blood loss. Furthermore, the results of JCOG 0212 would suggest that 93% of patients may have undergone LPLND unnecessarily.In this issue of Annals of Surgical Oncology, Miyake and colleagues report the use of a one-step nucleic acid amplification (OSNA) strategy to aid in the selection of patients at risk for lateral pelvic lymph node metastasis, who are candidates for prophylactic LPLND. The OSNA assay semiquantitatively detects the mRNA of cytokeratin 19 (CK19) and was developed for the purpose of rapidly identifying sentinel lymph node (SLN) metastasis during breast cancer surgery without the need for a pathologist to perform frozen-section evaluation. The strategy of identifying SLN metastases plays a critical role in operative decision making for patients with breast cancer; however, the utility of such a strategy has not been established in colorectal cancer, in part because mesenteric lymphadenectomy is still an obligatory part of colorectal cancer resection and adds no significant morbidity to the primary bowel resection. However, the addition of LPLND is not an obligatory procedure and itself is associated with increased operative time, blood loss, and potential for morbidity. Thus, there is a significant appeal to identify an easily performed, rapid intraoperative assessment to guide decision-making.While the OSNA assay may lack specificity, in this study it was highly sensitive with a high negative predictive value, even after preoperative chemotherapy. An OSNA-guided strategy could have avoided the need for prophylactic LPLND in 18 of 25 (72%) patients, and all 4 (16%) of the ...

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Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial

Cited by 314 publications

References 22 publications

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Tactics Sphincter Sparing Surgery in Locally-Advanced Rectal Ultra-Low Localisation With a Lesion of the Lateral Group Lymph Nodes: Clinical Cases

Selective Lateral Pelvic Lymph Dissection for Rectal Cancer

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