Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

Chen, Jia Nan; Liu, Zheng; Wang, Zhi Jie; Mei, Shi; Shen, Hai Yu; Li, Juan; Pei, Wei; Wang, Zheng; Wang, Xi Shan; Yu, Jun; Liu, Qian

doi:10.3748/wjg.v26.i21.2877

Cited by 21 publications

(22 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A meta‐analysis study including 241 rectal cancer patients with mucinous cancer conducted by McCawley et al showed that mucinous adenocarcinoma had a reduced rate of pathological complete response (OR = 0.078; 95% CI = 0.015–0.397; p = 0.002) and tumor downstaging (OR = 0.318; 95% CI = 0.185‐0.547; p < .001) following nCRT, which may be related to mucinous adenocarcinoma not being sensitive to chemoradiotherapy 19,20 . Chen et al analyzed the data of 63 patients with advanced low rectal cancer and suspected clinical LPNM, and they suggested that clinical T4 stage (95% CI: 1.419–18.508; p = 0.013), poor histological type (95% CI: 1.038–15.520; p = 0.044), and short‐axis diameter of LPN after nCRT ≥7 mm (95% CI: 1.487–38.214; p = 0.015) were independently associated with LPNM, which was consistent with our results 21 …”

Section: Discussionsupporting

confidence: 92%

“…18 In the present study, we also 1.038-15.520; p = 0.044), and short-axis diameter of LPN after nCRT ≥7 mm (95% CI: 1.487-38.214; p = 0.015) were independently associated with LPNM, which was consistent with our results. 21 Our research has several limitations and should be considered when interpreting the results. First, this is a single-center retrospective study involving only 151 patients, and its retrospective nature and the small size of the study population may have caused some bias.…”

Section: The European Society Of Gastrointestinal and Abdominalmentioning

confidence: 94%

See 1 more Smart Citation

Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications

Zhou

Jiang

Pei

et al. 2021

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background and Objectives: There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT).Methods: We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group (n = 73) and non-nCRT group (n = 78).Results: Thirty-one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03-43.03, p = 0.047) and post-nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87-247.91, p = 0.004) were independent risk factors for pathological LPNM.Conclusion: nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post-nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: The European Society Of Gastrointestinal and Abdominalmentioning

confidence: 94%

Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications

Zhou

Jiang

Pei

et al. 2021

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Local recurrence of rectal cancer remains an important clinical problem associated with poor survival, severe morbidity, and low likelihood if salvage. Lateral lymph node (LLN) metastasis, which occurs in approximately 15% of patients, is a leading cause of local recurrence in patients with lower rectal cancer [ 1 ]. In recent years, total mesorectum excision with a clear circumferential resection margin has become an established procedure for reducing local recurrence worldwide; however, the standard treatment strategies for the LLN area, such as chemoradiotherapy and LLN dissection, differ between western countries and eastern Asian countries in cases of lower rectal cancer [ 2 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

The middle rectal artery detected by contrast-enhanced magnetic resonance imaging predicts lateral lymph node metastasis in lower rectal cancer

Iwasa

Koyama

Marugami

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Lateral lymph node (LLN) metastasis is one of the leading causes of local recurrence in patients with lower rectal cancer. Unfortunately, no diagnostic biomarkers are currently available that can predict LLN metastasis preoperatively. Accordingly, we investigated the relationship between the middle rectal artery (MRA) identified by contrast-enhanced magnetic resonance imaging (ceMRI) and LLN metastases. Methods Data from 102 patients with lower rectal cancer who underwent surgery, and were evaluated by preoperative ceMRI, between 2008 and 2016 were reviewed retrospectively. Two expert radiologists evaluated the MRA findings. The diagnostic performance of MRA for LLN metastasis was evaluated by a multivariate analysis with conventional clinicopathological factors. Results The MRA was detected in 67 patients (65.7%), including 32 (31.4%) with bilateral MRA and 35 (34.3%) with unilateral MRA. The tumor size, presence of the MRA, and clinical LLN status were significantly correlated with LLN metastasis. A multivariate analysis demonstrated that the presence of MRA (P = 0.045) and clinical LLN status (P = 0.001) were independent predictive factors for LLN metastasis. Furthermore, the sensitivity and negative predictive value of MRA for LLN metastasis were 95% and 97.1%, respectively. Conclusion We successfully demonstrated that MRAs could be clearly detected by ceMRI, and the presence of MRA robustly predicted LLN metastasis in patients with lower rectal cancer, highlighting its clinical significance in the selection of more appropriate treatment strategies. Trial registration Trial registration number: retrospectively registered 2126 Trial registration date of registration: August 23, 2019

show abstract

“…However, in Asian countries, preoperative CRT plus TME is still the standard treatment strategy, as most surgeons do not perform LPLD, most commonly citing the extended operative time and potential nerve damage as the reasons. 38 Chen and his colleagues 38 reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LPLD. They found that LPLD was not sufficient for patients with mid or lower rectal cancer and that selective LPLD should be performed on the basis of a greater LPLN diameter, poorer histological differentiation, or advanced T stage.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lateral Pelvic Lymph Node Dissection for Rectal Cancer: A Meta-Analysis

Yang

Shang

Zhou

et al. 2021

Journal of Surgical Research

View full text Add to dashboard Cite

Background and aims: The benefit of lateral pelvic lymph node dissection (LPLD) for locally advanced rectal cancer remains controversial. This meta-analysis aimed to evaluate the prognostic value of LPLD in patients with locally advanced rectal cancer. Methods:We performed a systematic search in PubMed, Embase, and the Cochrane Library for publications comparing radical resection plus LPLD (LPLD group) with single radical resection (non-LPLD group) for locally advanced rectal cancer. A total of 15 studies satisfied our inclusion criteria and were assessed. Random-effects and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed.Results: LPLD significantly increased grade 3-4 postoperative complications (odds ratio[OR]1.44, 95% CI 1.03-2.02; P = 0.03) compared with non-LPLD. There were no significant differences in 5-y overall survival (hazard ratio = 0.90, 95% CI 0.77-1.05; P = 0.17), 5-y diseasefree survival (hazard ratio 1.12, 95% CI 0.60-2.09; P = 0.73), local recurrence (OR 0.89, 95% CI 0.53-1.51; P = 0.68) or distant recurrence (OR 0.85, 95% CI 0.64-1.12; P = 0.24). Conclusions:We found that LPLD significantly increased grade 3-4 postoperative complications but did not increase 5-y overall survival or 5-y disease-free survival compared with single radical resection for locally advanced rectal cancer. Furthermore, it did not decrease the local recurrence or distant recurrence rates. Thus, more multicenter large-scale randomized controlled trials should be conducted to further explore whether the long-term survival benefits of LPLD truly exist.

show abstract

Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

Cited by 21 publications

References 36 publications

Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications

Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications

The middle rectal artery detected by contrast-enhanced magnetic resonance imaging predicts lateral lymph node metastasis in lower rectal cancer

Prognostic Value of Lateral Pelvic Lymph Node Dissection for Rectal Cancer: A Meta-Analysis

Contact Info

Product

Resources

About