Retroperitoneal and Lateral Pelvic Lymphadenectomy Mapped by Lymphoscintigraphy for Rectal Adenocarcinoma Staging

Abstract

Retroperitoneal and lateral pelvic lymphadenectomy detected an important rate of metastatic retroperitoneal and/or lateral pelvic nodes (RLPN), resulting in upstaging. When markers migrated, they were able to detect RLPN metastases. The use of markers should be improved in the identification of RLPN metastases for selective indication of retroperitoneal and lateral pelvic lymphadenectomy.

Upstaging benefits and accuracy of sentinel lymph node mapping in colorectal adenocarcinoma nodal staging

“…This question was answered by our other ongoing trial [29], where 17 of 18 patients with lower rectal tumors described in this study had their retroperitoneal and lateral pelvic lymph nodes mapped by lymphoscintigraphy and blue dye [29]. Four of these 17 patients had their retroperitoneal and lateral nodes blue or radioactive, while only 1 of these 4 patients did not have SLN identification in the mesorectum.…”

“…Patients with rectal cancer were also enrolled in a second ongoing trial, in which retroperitoneal and lateral pelvic lymphadenectomy were added to the standard total mesorectal excision [29]. All surgical specimens were accessed by a single pathologist, the third author.…”

Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma

“…Local and national ethics committees approved this trial, and written informed consent was obtained from all patients. Between January 2004 and January 2007, 102 patients with rectal adenocarcinoma located at or below the peritoneal reflection, with TNM stage II and III established in preoperative exams, were enrolled in a previous prospective study 8, 9. Patients who agreed to participate in the study were enrolled, without selection of patients who might be suitable for TME plus RLPL.…”

“…This study presents the follow‐up data for morbidity, recurrence, and survival rates of a cohort of patients with low rectal adenocarcinoma that was included in a previous trial 8. All patients were treated with TME plus RLPL, and patients with T3/T4 tumors or metastases to mesorectal lymph nodes or RLPNs underwent additional chemoradiotherapy.…”

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

“…[7][8][9] Lymphoscintigraphy for staging purposes suggests that 40% of technetium-99 m-colloid migrates to extramesenteric lymph nodes in patients with rectal cancer. 10,11 There has been long-standing controversy as to whether extramesenteric lymph node metastases (EMLNM) represent systemic disease, that is, M1 as determined by the current TNM classification (7th edition) or localized disease (N3) as outlined in the current Japanese guidelines. 12,13 Total mesorectal excision (TME), the precise dissection of the rectum and all of the mesenteric lymph nodes within the mesorectal envelope, is now universally acknowledged as the optimal treatment for most rectal cancers.…”