Preoperative chemoradiotherapy changes the size criterion for predicting lateral lymph node metastasis in lower rectal cancer

Yamaoka, Yusuke; Kinugasa, Yusuke; Shiomi, Akio; Yamaguchi, Takashi; Kagawa, Hiroyasu; Yamakawa, Yushi; Numata, Masakatsu; Furutani, Akira

doi:10.1007/s00384-017-2873-x

Cited by 27 publications

(29 citation statements)

References 36 publications

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“…While the role of nCRT for LPNM has become clearer in recent years, it is well recognized that nCRT cannot eliminate all malignant cells within LPNs. The results of this study suggest that LPNM is influenced by both post-nCRT size and the sensitivity of LPN classification [19,23,24]. Oh et al [19] reported that persistent LPNs ≥ 5 mm on post-nCRT MRI were more significantly associated with residual tumour metastasis than responsive LPNs after nCRT (61.1% vs 0%, P = 0.001), and multivariable analysis revealed post-nCRT LPN size to be a significant and independent risk factor for LPNM (OR = 2.390; 95% CI = 1.104-4.069, P = 0.001).…”

Section: Discussionmentioning

confidence: 85%

“…Oh et al [19] reported that persistent LPNs ≥ 5 mm on post-nCRT MRI were more significantly associated with residual tumour metastasis than responsive LPNs after nCRT (61.1% vs 0%, P = 0.001), and multivariable analysis revealed post-nCRT LPN size to be a significant and independent risk factor for LPNM (OR = 2.390; 95% CI = 1.104-4.069, P = 0.001). Yamaoka et al [23] also found that in the nCRT group, the optimal cut-off value of post-nCRT LPN size was 5 mm, with a sensitivity of 71.4% and specificity of 85.3% for positive LPNM. Inoue et al [24], however, considered a 7 mm cut-off more appropriate.…”

Section: Discussionmentioning

confidence: 93%

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Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy

Wang

Zhou

et al. 2019

Colorectal Disease

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Aim The need or otherwise for lateral pelvic node dissection (LPND) in rectal cancer patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT) is controversial. This study was designed to explore the predictive factors for pathological LPNM in rectal cancer patients with clinical LPNM after nCRT.Method From January 2010 to February 2018, a consecutive series of patients with rectal cancer and clinical LPNM after nCRT who underwent total mesorectal excision and LPND were reviewed. Patient demographics, operative and pathological outcomes were collected and analysed.Results A total of 76 consecutive cases were included in this study: 53 (69.7%) patients underwent unilateral LPND and 23 (30.3%) bilateral LPND. The pathological results showed that LPNM was found in 13 (17.1%) patients. Multivariate logistic regression analysis showed that the post-nCRT lateral pelvic node size ≥ 5 mm (OR = 7.67, 95% CI = 1.45-40.63, P = 0.017) and mucinous/signet-ring adenocarcinoma (OR = 4.60, 95% CI = 1.11-19.08, P = 0.035) were independent risk factors for pathological LPNM.Conclusion Post-nCRT lateral pelvic node size ≥ 5 mm and mucinous/signet-ring adenocarcinoma were independent predictive factors of pathological LPNM for rectal cancer patients with clinical LPNM after nCRT, and patients with these characteristics may benefit from LPND.What does this paper add to the literature? The aim of this paper was to determine the optimal indication for lateral pelvic node dissection after neoadjuvant chemoradiotherapy for mid/low rectal cancer, so as to avoid the occurrence of overtreatment in clinical work.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 93%

Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy

Wang

Zhou

et al. 2019

Colorectal Disease

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“…There are some limitations to this study: it is a retrospective study based on a case series collected over 11 years; sample size is relatively small (104) even though comparable to various other publications5 21; a small number of events occurred during follow-up as expected in this setting. On the other hand, the fact that all samples are from a single centre with few dedicated surgeons, oncologists and subspecialised pathologists, thus minimising variability in treatment and histology protocols, should be considered as a strength.…”

Section: Discussionmentioning

confidence: 97%

Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer

Pitto

Zoppoli²,

Scabini

et al. 2019

J Clin Pathol

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AimsNeoadjuvant chemoradiotherapy (neoCRT) is recommended for locally advanced rectal cancer (RC), however, this often makes lymph node (LN) search trying. The aim of this study was to evaluate, in a large retrospective, monocentric, series of post-neoCRT-RC patients, the importance of LN number, ratio and surface area in predicting metastases, overall survival (OS) and disease free survival (DFS).Methods104 patients with RC underwent total mesorectal excision, after standard neoCRT. All resected specimens were examined according to a standardised sampling/histopathological protocol. The following data regarding LNs were collected: total numbers; number with metastases; LNratio (metastatic/total); maximum diameter; surface area.ResultsA statistically significant association was found between LN number and DFS (p=0.0473). Finding ≤9 or >20 LNs correlated with worse prognosis compared with 10–20 (p value=0.049). LNratio (>0.2) was strongly associated with shorter DFS (HR=13.36; p value <0.0001) and OS (HR=26.06; p value <0.0001). Poor outcome, for DFS (HR=2.17, p value =0.0416) and OS (HR=1.18, p value =0.0025), was associated with increasing LN surface area. LNratio was independently associated with DFS at multivariate analysis (p value <0.0001).ConclusionsLN number, LNratio and LN surface area are important prognostic factors in neoCRT-RC and in particular finding ≤9 or >20 LNs is prognostically adverse.

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“…Ishihara et al reported that the incidence of LLN metastasis was estimated to be 8.1% (18/222) even after preoperative CRT. Yamaoka et al also reported that LLN metastasis was detected in seven out of 19 patients who underwent preoperative CRT, suggesting preoperative CRT followed by ME alone is not sufficient, especially when LLN involvement is clinically suspicious . Ishihara's group carried out TME + LLND for patients with swollen LLN following preoperative CRT .…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Akiyoshi's group reported that the optimal cut‐off value before CRT was 8 mm . Yamaoka reported an optimal cut‐off value of 6.0 mm, with a sensitivity of 78.5% and a specificity of 82.9% . Before the start of preoperative treatment, accurate estimation of LLN size by MRI is useful.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Recent updates in the surgical treatment of colorectal cancer

Matsuda

Yamashita

Hasegawa

et al. 2018

Annals of Gastroent Surgery

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Because of recent advances in medical technology and new findings of clinical trials, treatment options for colorectal cancer are evolutionally changing, even in the last few years. Therefore, we need to update the treatment options and strategies so that patients can receive optimal and tailored treatment. The present review aimed to elucidate the recent global trends and update the surgical treatment strategies in colorectal cancer by citing the literature published in the last 2 years, namely 2016 and 2017. Although laparoscopic surgery is still considered the most common approach for the treatment of colorectal cancer, new surgical technologies such as transanal total mesorectal excision, robotic surgery, and laparoscopic lateral pelvic lymph node dissection are emerging. However, with the recent evidence, superiority of the laparoscopic approach to the open approach for rectal cancer seems to be controversial. Surgeons should notice the risk of adverse outcomes associated with unfounded and uncontrolled use of these novel techniques. Many promising results are accumulating in preoperative and postoperative treatment including chemotherapy, chemoradiotherapy, and targeted therapy. Development of new biomarkers seems to be essential for further improvement in the treatment outcomes of colorectal cancer patients.

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Preoperative chemoradiotherapy changes the size criterion for predicting lateral lymph node metastasis in lower rectal cancer

Abstract: The cutoff size for determining lateral lymph node metastasis was smaller in the CRT group than in the non-CRT group.

Cited by 27 publications

References 36 publications

Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy

Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy

Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer

Recent updates in the surgical treatment of colorectal cancer

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