TY - JOUR
T1 - Oncologic impact of lateral lymph node metastasis at the distal lateral compartment in locally advanced low rectal cancer after neoadjuvant (chemo)radiotherapy
AU - Akiyoshi, Takashi
AU - Yamaguchi, Tomohiro
AU - Hiratsuka, Makiko
AU - Mukai, Toshiki
AU - Hiyoshi, Yukiharu
AU - Nagasaki, Toshiya
AU - Ueno, Masashi
AU - Fukunaga, Yosuke
AU - Konishi, Tsuyoshi
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: The frequency and oncologic outcomes of lateral lymph node (LLN) metastasis at the most distal lateral compartment (DLC) among clinical stage II-III low rectal cancer patients treated with neoadjuvant (chemo)radiotherapy (nCRT) are poorly understood. The aim was to investigate the oncologic impact of LLN metastasis in the DLC versus the proximal lateral compartment (PLC). Materials and methods: Consecutive patients with low rectal cancer treated with nCRT followed by total mesorectal excision and selective LLN dissection including the DLC were analyzed retrospectively. DLC was defined as the area distal to the infra–piriformis foramen on axial MRI images. Size and location of LLN metastasis on MRI, and survival were retrospectively assessed. Results: Of the 718 patients, 72 (10.0%) had pathological LLN metastasis. Thirty-two (44.4%) had metastasis in the DLC (DLC group), while 40 (55.6%) had metastasis in the PLC without metastasis in the DLC (PLC group). The proportion of ypN2 category tended to be lower in the DLC group (15.6% vs 35.0%, P = 0.105). The median number of metastatic LLN was similar (1 vs. 1, P = 0.691). The median short-axis size of metastatic LLN was smaller in the DLC group than in the PLC group on pre-treatment (P < 0.001) and re-staging (P = 0.004) MRI. By multivariable analysis, LLN metastasis in the DLC was predictive of better disease-free survival (HR, 0.412; 95% CI, 0.159–0.958, P = 0.039). Conclusion: LLN metastasis in the DLC is frequent and has favorable oncologic outcomes after surgical dissection with nCRT.
AB - Introduction: The frequency and oncologic outcomes of lateral lymph node (LLN) metastasis at the most distal lateral compartment (DLC) among clinical stage II-III low rectal cancer patients treated with neoadjuvant (chemo)radiotherapy (nCRT) are poorly understood. The aim was to investigate the oncologic impact of LLN metastasis in the DLC versus the proximal lateral compartment (PLC). Materials and methods: Consecutive patients with low rectal cancer treated with nCRT followed by total mesorectal excision and selective LLN dissection including the DLC were analyzed retrospectively. DLC was defined as the area distal to the infra–piriformis foramen on axial MRI images. Size and location of LLN metastasis on MRI, and survival were retrospectively assessed. Results: Of the 718 patients, 72 (10.0%) had pathological LLN metastasis. Thirty-two (44.4%) had metastasis in the DLC (DLC group), while 40 (55.6%) had metastasis in the PLC without metastasis in the DLC (PLC group). The proportion of ypN2 category tended to be lower in the DLC group (15.6% vs 35.0%, P = 0.105). The median number of metastatic LLN was similar (1 vs. 1, P = 0.691). The median short-axis size of metastatic LLN was smaller in the DLC group than in the PLC group on pre-treatment (P < 0.001) and re-staging (P = 0.004) MRI. By multivariable analysis, LLN metastasis in the DLC was predictive of better disease-free survival (HR, 0.412; 95% CI, 0.159–0.958, P = 0.039). Conclusion: LLN metastasis in the DLC is frequent and has favorable oncologic outcomes after surgical dissection with nCRT.
KW - Advanced low rectal cancer
KW - Distal lateral compartment
KW - Lateral lymph node metastasis
KW - Neoadjuvant (chemo)radiotherapy
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U2 - 10.1016/j.ejso.2021.07.011
DO - 10.1016/j.ejso.2021.07.011
M3 - Article
C2 - 34284904
AN - SCOPUS:85110510031
SN - 0748-7983
VL - 47
SP - 3157
EP - 3165
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 12
ER -