Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

Abstract

AIM:To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHOD S :A t o t a l o f 9 6 c o n s e c u t i v e p a t i e n t s who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS:Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (χ 2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ 2 = 27.944, P = 0.0001).The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ 2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (χ 2 = 22.308, P = 0.0001).Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95%CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION:Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

Variation in circumferential resection margin: Reporting and involvement in the South-Netherlands

“…11,12,27,28 Also pathologically proven N2 stage was associated with high CRM involvement (data not shown). West et al 10 previously explained this by the fact that pN2 stage rectal cancer is related with more extensive primary tumors (T3 or T4 stage) and therefore with a higher incidence of CRM involvement.…”

EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer

“…15,50,63,64 In addition, endoscopy and EUS findings associated with EMLNM, included tumor length of 4 cm or longer, annularity of 50% or greater, sessile morphology, and nodal size, which also are in keeping with existing established surgical pathology findings. 9,47 Furthermore, 15 of 82 of patients with a visualized extramesenteric node had early rectal cancer, 4 of 15 of whom had EMLNM, thus reiterating the findings from our previous study that conventional characteristic EUS individual echo features alone or in combination do not have sufficient accuracy for predicting nodal metastasis in patients with rectal cancer. 55 Surgical pathology or imaging indicators for extramesenteric lymph nodes have not been well documented.…”

“…It would appear that individuals with EMLNM may be a distinct subgroup at increased risk of local recurrence and worse prognosis. 24,[44][45][46][47][48][49][50][51] Currently, details pertaining to extramesenteric lymph nodes may be retrieved from patients undergoing surgery in the absence of neoadjuvant therapy or patients in whom such nodes undergo biopsy or that are surgically excised. The sensitivity and specificity of rigid endoscopic rectal US (360-degree radial transducer) in the detection of mesenteric lymph node metastases is 58% and 82%, respectively.…”

Chirurgie des kolorektalen Karzinoms

“…Bekannte Risikofaktoren waren tiefer Tumorsitz, mesorektale Lymphknotenmetastasen, tief infiltrierender Tumor und schlechter Differenzierungsgrad. Ganz ähnliche Risikofaktoren wurden an 96 retrospektiv ausgewerteten Fällen in China erhoben: Tumorgröße > 5 cm, schlechte Differenzierung und tiefe Infiltration [54].…”