Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer

Abstract

AIMTo assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer.METHODSWe selected 71 consecutive stage IV low rectal cancer patients who underwent primary tumor resection, and enrolled 50 of these 71 patients without clinical LPLN metastasis. The patients had distant metastasis such as liver, lung, peritoneum, and paraaortic LN. Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan. All patients underwent primary tumor resection, 27 patients underwent total mesorectal excision (TME) with LPLND (LPLND group), and 23 patients underwent only TME (TME group). Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group. R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients. We evaluated possible prognostic factors for 5-year overall survival (OS), and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTSFor OS, univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%, P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor. Regarding cumulative local recurrence, the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%, P = 0.833).CONCLUSIONProphylactic LPLND shows no oncological benefits in patients with Stage IV low rectal cancer without clinical LPLN metastasis.

Effective dissection for rectal cancer with lateral lymph node metastasis based on prognostic factors and recurrence type

“…Kanemitsu et al reported that, according to the index of the estimated benefits derived from LLND, dissection of the internal iliac and obturator nodes yielded similar therapeutic benefits as those expected from the dissection of the superior rectal artery lymph nodes [ 15 ]. Furthermore, Tamura et al reported no oncological benefit from performing LLND in patients with stage IV disease who had both lateral and distant lymph node metastases [ 33 ]. Oh et al reported that 59.1% of their patients with lateral lymph node metastases who underwent LLND also had distant metastases and poor prognoses [ 34 ].…”

Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

“…Seventeen studies [ 7 , 17 , 42 , 45 , 46 , 48 , 49 , 52 , 53 , 57 – 61 , 64 , 66 , 68 , 69 ] reported local recurrence in 6613 patients (2.924 LLND and 3689 NLLND). The incidence of local recurrence was not statistically different between the overall LLND group (10.7%, 312/2.924) and the overall NLLND group (12.1%, 448/3.689) (RR 0.89, 95% CI 0.69 to 1.14; I 2 = 49%, P =0.36) (Fig.…”

“…Ten studies [ 41 , 45 , 46 , 52 , 53 , 55 , 58 – 60 , 64 , 69 ], including 5132 patients (2560 LLND and 2572 NLLND), reported the rate of this outcome. The overall survival at 5 years was not statistically different between the LLND group (76.6%) and the NLLND group (74.6%), (RR 0.90, 95% CI 0.79 to 1.01; I 2 = 17%) (Fig.…”

Role of pelvic lymphadenectomy in rectal cancer

“…In the study Tamura et al study, all patients received R0 resection of primary site with the operative procedure as follows: 31 patients received low anterior resection, 18 patients received abdominoperineal resection, 1 patient received pelvic exenteration. 17 In this study, all patients received R0 resection of primary site with the operative procedure as follows: 15 patients received low anterior resection, 2 patients received abdominoperineal resection, 2 patients received ultralow anterior resection, 1 patient receive Intersphincteric resection.…”