TY - JOUR
T1 - Prognostic Impact of Lateral Pelvic Node Dissection on the Survival of Patients in Low Rectal Cancer Subgroups Based on Lymph Node Size
AU - On behalf of Japan Society of Laparoscopic Colorectal Surgery
AU - Hida, Koya
AU - Nishizaki, Daisuke
AU - Sumii, Atsuhiko
AU - Okamura, Ryosuke
AU - Sakai, Yoshiharu
AU - Konishi, Tsuyoshi
AU - Akagi, Tomonori
AU - Yamaguchi, Tomohiro
AU - Akiyoshi, Takashi
AU - Fukuda, Meiki
AU - Yamamoto, Seiichiro
AU - Arizono, Shigeki
AU - Uemura, Mamoru
AU - Hasegawa, Hirotoshi
AU - Kawada, Kenji
AU - Morita, Satoshi
AU - Watanabe, Masahiko
N1 - Funding Information:
We thank the following doctors and clinical research coordinators who cooperated in this study: Koji Tokunaga, Shigeshi Kohno, Hirotsugu Nakai, Ayako Ono, and Toshiyuki Sato (Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital), and the doctors listed in the previous paper.26
Funding Information:
K.H. received grants for research (regarding the treatment of rectal cancer) from Japan Society of Clinical Oncology, the Japanese Foundation for Research and Promotion of Endoscopy, Kondou Kinen Medical Foundation, and Senko Medical Instrument. For study design, data collection, data analysis, manuscript preparation, and publication decisions, there was no involvement of the funders. A.S.—Japan Society of Clinical Oncology, The Japanese Foundation for Research and Promotion of Endoscopy, Kondo Kinen Foundation, Senko Medical Instrument
Publisher Copyright:
© 2021, Society of Surgical Oncology.
PY - 2021/10
Y1 - 2021/10
N2 - Background: Lateral pelvic node (LPN) dissection (LPND) is considered a promising technique for treating low rectal cancer; however, there is insufficient evidence of its prognostic value. Using centrally reviewed preoperative pelvic magnetic resonance (MR) images, this study aimed to find the patient population who has benefited from LPND. Patients and Methods: MR images of patients from 69 institutes with stage II–III low rectal cancer were reviewed by experienced radiologists. Recurrence-free survival (RFS), overall survival (OS), and short-term outcomes were measured. Results: In total, 731 preoperative MR images were reviewed (excluding patients with short-axis LPN ≥ 10 mm). Of these, 322 underwent total mesorectum excision (TME) without LPND (non-LPND group), and 409 underwent TME with LPND (LPND group). Preoperative treatment was performed for 40% and 25% of patients in the non-LPND and LPND groups, respectively. The incidence of postoperative complications was higher in the LPND group (44.5%) than in the non-LPND group (33.2%; P = 0.002). Among patients with LPNs < 5 mm, OS and RFS curves were not significantly different between the groups. Among patients with LPNs ≥ 5 mm, the LPND group had significantly higher 5-year OS and RFS than the non-LPND group (OS: 81.9% versus 67.3%; RFS: 69.4% versus 51.6%). On multivariate analysis of LPN ≥ 5 mm cases, LPND was independently associated with RFS. Conclusions: Despite the high incidence of postoperative complications, this study showed the prognostic impact of LPND on low rectal cancer patients with LPNs (≥ 5 mm, < 10 mm short axis) measured by experienced radiologists.
AB - Background: Lateral pelvic node (LPN) dissection (LPND) is considered a promising technique for treating low rectal cancer; however, there is insufficient evidence of its prognostic value. Using centrally reviewed preoperative pelvic magnetic resonance (MR) images, this study aimed to find the patient population who has benefited from LPND. Patients and Methods: MR images of patients from 69 institutes with stage II–III low rectal cancer were reviewed by experienced radiologists. Recurrence-free survival (RFS), overall survival (OS), and short-term outcomes were measured. Results: In total, 731 preoperative MR images were reviewed (excluding patients with short-axis LPN ≥ 10 mm). Of these, 322 underwent total mesorectum excision (TME) without LPND (non-LPND group), and 409 underwent TME with LPND (LPND group). Preoperative treatment was performed for 40% and 25% of patients in the non-LPND and LPND groups, respectively. The incidence of postoperative complications was higher in the LPND group (44.5%) than in the non-LPND group (33.2%; P = 0.002). Among patients with LPNs < 5 mm, OS and RFS curves were not significantly different between the groups. Among patients with LPNs ≥ 5 mm, the LPND group had significantly higher 5-year OS and RFS than the non-LPND group (OS: 81.9% versus 67.3%; RFS: 69.4% versus 51.6%). On multivariate analysis of LPN ≥ 5 mm cases, LPND was independently associated with RFS. Conclusions: Despite the high incidence of postoperative complications, this study showed the prognostic impact of LPND on low rectal cancer patients with LPNs (≥ 5 mm, < 10 mm short axis) measured by experienced radiologists.
UR - http://www.scopus.com/inward/record.url?scp=85110118792&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110118792&partnerID=8YFLogxK
U2 - 10.1245/s10434-021-10312-7
DO - 10.1245/s10434-021-10312-7
M3 - Article
C2 - 34255243
AN - SCOPUS:85110118792
SN - 1068-9265
VL - 28
SP - 6179
EP - 6188
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 11
ER -