The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum

Ogawa, Shimpei; Hida, Jin‐ichi; Ike, Hideyuki; Kinugasa, Tetsushi; Ota, Mitsuyoshi; Shinto, Eiji; Itabashi, Michio; Okamoto, Takahiro; Sugihara, Kenichi

doi:10.1007/s00384-016-2641-3

Cited by 35 publications

(25 citation statements)

References 21 publications

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“…A previous study identified the risk factors for LLNM as female sex, lower rectal cancer location, lymphatic invasion, venous invasion, wall progression, and paraintestinal lymph node metastasis ≥ 5 mm in width on magnetic resonance imaging [ 35 ]. Another group found that the diagnostic ability for LLNM is more promising at a short axis of 5 mm than it is at 10 mm [ 36 ]. However, there are reports of pathological lymph node metastases being found in approximately half of the lymph nodes that were judged to be small (< 5 mm) on diagnostic imaging [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

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

Morohashi

Sakamoto

Miura

et al. 2021

Int J Colorectal Dis

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Purpose There are no reports showing the significance and effective range of dissection for patients with lateral lymph node metastasis (LLNM). This study aimed to investigate the indications for lateral lymph node dissection (LLND) in patients with LLNM based on prognostic factors and recurrence types. Methods We reviewed 379 patients with advanced rectal cancer who were treated with total mesorectal excision plus LLND. We analyzed background factors and survival times of patients who had LLNM to determine prognostic factors and recurrence types. Results Pathological LLNM occurred in 44 (11.6%). Among patients with LLNM, the predictors of poor prognoses, according to univariate analysis, were > 3 node metastases, the presence of node metastasis on both sides, and spreading beyond the internal iliac lymph nodes. Moreover, LLNM beyond the internal iliac region was found to be an independent prognostic risk factor. Twenty-eight of the 44 patients with lateral lymph node metastasis (64%) relapsed, 22 of whom had distant metastases and 11 of whom experienced local recurrences. Among the latter group, nine (20%) and two (5%) had recurrences in the central and lateral pelvis, respectively. Conclusion The therapeutic benefit of resection was high, especially in patients with ≤ 3 positive lateral lymph nodes, one-sided bilateral lymph node areas, and positive nodes localized near the internal iliac artery.

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Section: Discussionmentioning

confidence: 99%

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

Morohashi

Sakamoto

Miura

et al. 2021

Int J Colorectal Dis

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“…Additionally, several risk factors for positive lateral lymph nodes have been reported previously. Preoperative risk factors include age, sex, tumor location, depth of invasion, central nodal involvement, and lateral node size [13][14][15][16][17][18][19][20][21][22][23]. Studies on the size of lymph nodes in terms of the major or minor axis and various lengths have been conducted; however, in this study, lateral lymph nodes with minor axes shorter than 7.0 mm, as identified using CT and magnetic resonance imaging, constituted the criterion for negative metastasis, and many institutions in Japan now use this criterion.…”

Section: Discussionmentioning

confidence: 99%

Is prophylactic lateral lymph node dissection needed for lower rectal cancer? A single-center retrospective study

et al. 2021

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Background The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer. Methods Data of 301 patients with lower rectal cancer (tumor’s lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups. Results Significantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups. Conclusions In this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.

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“…Prior studies have reported that the assessment of LNs in CRC by any imaging modality is difficult because LN size alone is not a consistent diagnostic criterion of metastatic involvement. 9,34 Other studies have demonstrated that although ADC values may be valuable to identify metastatic LNs, it is often problematic to discriminate between metastatic and nonmetastatic LNs on the basis of ADC values alone because of the considerable overlap between the ADC values of metastatic and nonmetastatic LNs. [35][36][37][38] Based on the ability to predict microstructural complexity, QSI may be a useful tool for noninvasive evaluation of the extent of LNM in CRC.…”

Section: Discussionmentioning

confidence: 99%

“…QSI was also useful to discriminate between metastatic and nonmetastatic LNs in CRC. Prior studies have reported that the assessment of LNs in CRC by any imaging modality is difficult because LN size alone is not a consistent diagnostic criterion of metastatic involvement . Other studies have demonstrated that although ADC values may be valuable to identify metastatic LNs, it is often problematic to discriminate between metastatic and nonmetastatic LNs on the basis of ADC values alone because of the considerable overlap between the ADC values of metastatic and nonmetastatic LNs .…”

Section: Discussionmentioning

confidence: 99%

Colorectal carcinoma: Ex vivo evaluation using q‐space imaging; Correlation with histopathologic findings

Yamada

Hikishima

Yoshino

et al. 2018

Magnetic Resonance Imaging

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The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum

Abstract: An LPLN-positive status with a short axis ≥5 mm on MRI is an important predictor of LPLN metastasis, but PRLN status is not a strong predictor of PRLN metastasis.

Cited by 35 publications

References 21 publications

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

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

Is prophylactic lateral lymph node dissection needed for lower rectal cancer? A single-center retrospective study

Colorectal carcinoma: Ex vivo evaluation using q‐space imaging; Correlation with histopathologic findings

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