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World J Gastroenterol. Dec 7, 2007; 13(45): 6048-6052
Published online Dec 7, 2007. doi: 10.3748/wjg.v13.i45.6048
Prognostic value of lateral lymph node metastasis for advanced low rectal cancer
Ze-Yu Wu, Jin Wan, Jing-Hua Li, Gang Zhao, Yuan Yao, Jia-Lin Du, Quan-Fang Liu, Lin Peng, Zhi-Du Wang, Zhi-Ming Huang, Hua-Huan Lin
Ze-Yu Wu, Jin Wan, Gang Zhao, Yuan Yao, Jia-Lin Du, Quan-Fang Liu, Lin Peng, Zhi-Du Wang, Zhi-Ming Huang, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
Jing-Hua Li, Department of Clinical Laboratory, The First Affiliated Hospital Huangpu Division, Sun Yat-Sen University, Guangzhou 510089, Guangdong Province, China
Hua-Huan Lin, Department of Pathology, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
Author contributions: All authors contributed equally to the work.
Supported by the WST Foundation of Guangdong Province, No. 2000112736580706003
Correspondence to: Dr. Jin Wan, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China. reiqi123@sohu.com
Telephone: +86-20-83827812-60821 Fax: +86-20-83827812
Received: July 11, 2007
Revised: September 13, 2007
Accepted: October 18, 2007
Published online: December 7, 2007
Abstract

AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer.

METHODS: A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified.

RESULTS: Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (χ2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (χ2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95% CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001).

CONCLUSION: Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

Keywords: Low rectal cancer, Lateral lymph node metastasis, Local recurrence, Prognosis