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Takamizawa Y, Nagata H, Moritani K, Tsukamoto S, Kanemitsu Y. Transition to lateral lymph node dissection in rectal cancer: Forty-five years of outcomes data. Surgery 2025; 182:109304. [PMID: 40068269 DOI: 10.1016/j.surg.2025.109304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 01/31/2025] [Accepted: 02/02/2025] [Indexed: 05/25/2025]
Abstract
PURPOSE To determine how outcomes of lateral lymph node dissection for rectal cancer have changed over time. METHODS This retrospective study included patients with rectal cancer without distant metastasis who underwent total mesorectal excision and lateral lymph node dissection at our institution between 1975 and 2020. We examined the association of surgical time period with relapse-free and overall survival. Multivariable analyses were performed using Cox proportional hazards regression models. RESULTS Among a total of 992 patients, 386 underwent surgery in 1975-2000, 296 in 2001-2010, and 310 in 2011-2020. Overall, 924 patients (93%) underwent surgery without preoperative therapy. The respective 5-year relapse-free survival rates were 64.2%, 64.2%, and 68.2% (P = .314), and the 5-year overall survival rates were 72.3%, 84.0%, and 89.3% (P < .001). Overall survival could be stratified by surgical time period, especially stage III (P < .001). In patients with lateral lymph node metastasis, the 5-year overall survival rate was 43.5% in 1975-2000, 61.1% in 2001-2010, and 71.1% in 2011-2020 (P = .003). Multivariable analysis revealed significant differences in overall survival between 2011-2020 and 1975-2000 (hazard ratio, 2.81; P < .001) and between 2011-2020 and 2001-2010 (hazard ratio, 1.59; P = .040), but not in relapse-free survival. CONCLUSION The impact of lateral lymph node dissection on rectal cancer treatment may not have changed in 45 years, given the lack of difference in relapse-free survival. Treatment outcomes after recurrence may have improved. The prognosis remains poor for lateral lymph node metastasis, highlighting the need for further development of multimodality treatments.
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Affiliation(s)
- Yasuyuki Takamizawa
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Hiroshi Nagata
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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Murofushi KN, Tsujino K, Ito Y, Okamoto M, Doi H, Ogawa H, Onozawa M, Kawamoto T, Katoh N, Jingu K, Takeda A, Nihei K, Makishima H, Mayahara H, Yamazaki H, Igaki H. Contouring atlas and essential points for radiotherapy in rectal cancer. JOURNAL OF RADIATION RESEARCH 2025; 66:203-211. [PMID: 40151044 PMCID: PMC12100485 DOI: 10.1093/jrr/rraf013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 02/10/2025] [Accepted: 02/27/2025] [Indexed: 03/29/2025]
Abstract
In the last decade, the role of radiotherapy in rectal cancer has changed significantly with the introduction of total neoadjuvant therapy (TNT) and nonoperative management (NOM). For the setting of irradiation field in rectal cancer, the pararectal, lateral lymph nodes, and those along the inferior mesenteric artery (IMA) are most important. In total mesorectal excision (TME), the root of the IMA is dissected. In the atlas of pelvic irradiation for rectal cancer, the setting of the upper margin of the mesorectum varies from atlas to atlas, and no atlas sets the upper margin of the mesorectum to the root of the IMA. In particular, there is no consensus on the definition of anatomical boundaries regarding the lymph nodes along the superior rectal artery (SRA). The upper margin of the irradiation field in clinical trials of preoperative radiotherapy and TNT is generally set at the level of the internal and external iliac artery branches, L5/S1, or S2/S3. However, it is not necessary to include the entire mesorectum to the root of the IMA in patients undergoing preoperative radiotherapy plus TME. Conversely, for patients receiving NOM, the irradiation field may have to include the mesorectum to the IMA root, though the incidence of lymph node metastasis and gastrointestinal adverse events merits consideration. It is increasingly important to determine the extent of clinical target volume around the SRA region and the setting of the upper margin of the irradiation field after formulating the treatment policy together with the surgeons and medical oncologists.
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Affiliation(s)
- Keiko Nemoto Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70 Kitaojicho, Akashi-shi, Hyogo, 673-0021, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hirofumi Ogawa
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Masakatsu Onozawa
- Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi-shi, Chiba, 273-8588, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, N15-W7, Kitaku, Sapporo 060-868, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Atsuya Takeda
- Department of Radiology, Keio University School of Medicine, 35, Shinano, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Keiji Nihei
- Department of Radiation Oncology, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki-shi, Osaka 569-8686, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsubuka, Ibaraki 305-8576, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuou-Ku, Kobe, Hyogo 650-0046, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Yokota M, Morikawa A, Matsuoka H, Nagahisa Y, Kawata K, Okabe M, Masui T, Kawamoto K. Minimally Invasive Robotic Surgery in Lateral Lymph Node Dissection by Pelvic Floor First Approach. Dis Colon Rectum 2025; 68:e200-e201. [PMID: 39907247 DOI: 10.1097/dcr.0000000000003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Affiliation(s)
- Mitsuru Yokota
- Department of General Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Cho MJ, Han K, Shin HJ, Koom WS, Lee KY, Kim JH, Lim JS. MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy. Eur Radiol 2025:10.1007/s00330-025-11439-x. [PMID: 39939420 DOI: 10.1007/s00330-025-11439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 12/21/2024] [Accepted: 01/24/2025] [Indexed: 02/14/2025]
Abstract
OBJECTIVES To develop scoring systems to predict the need for selective lateral lymph node dissection (LLND) alongside total mesorectal excision (TME) in patients with locally advanced low rectal cancer after neoadjuvant chemoradiotherapy (nCRT), focusing on lateral local recurrence (LLR) and lateral lymph node (LLN) metastasis. MATERIALS AND METHODS This retrospective study included 607 patients with mrT3/T4 rectal cancer located within 8 cm of the anal verge who underwent nCRT and TME. A development group was used to develop a scoring system predicting the necessity of LLND using logistic regression analysis, incorporating primary tumor and LLN features observed on rectal MRI. External validation was performed in an independent group of 144 patients. We also analyzed risk factors for recurrence and residual LLNs after LLND. RESULTS Model 1 included pretreatment LLN size and extramural venous invasion (EMVI). Model 2 incorporated pretreatment internal iliac and obturator lymph node sizes, EMVI, and nonresponsive LLN on restaging MRI. Model 3 focused solely on nonresponsive LLN on restaging MRI. In the development group, Models 1 and 2 exhibited better performance (area under the curve (AUC) = 0.92 and 0.90, respectively) than Model 3 (AUC = 0.79), consistent with the validation group. Among patients who underwent LLND, the distal internal iliac compartment had more residual lymph nodes than other compartments (p = 0.02). CONCLUSION Scoring systems utilizing LLN features and EMVI on MRI might aid in decision-making for selective LLND following nCRT in locally advanced low rectal cancer. KEY POINTS Question The criteria for when additional lateral lymph node dissection (LLND) may benefit in locally advanced low rectal cancer have not yet been definitively established. Findings Scoring systems (Model 1, 2) based on preoperative MRI utilize lateral lymph node (LLN) size and extramural venous invasion to predict the necessity of LLND. Clinical relevance The selective LLND along with total mesorectal excision aids in managing LLN metastasis and lateral local recurrence in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy. The imaging-based scoring systems may guide clinical decision-making for selective LLND.
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Affiliation(s)
- Min Jeong Cho
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joo Hee Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Yamaguchi T, Akiyoshi T. Surgical anatomy of lateral lymph node dissection: landmarks and areas of dissection in minimally invasive surgery. Tech Coloproctol 2025; 29:60. [PMID: 39903364 DOI: 10.1007/s10151-024-03078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 11/25/2024] [Indexed: 02/06/2025]
Abstract
Lateral lymph node dissection (LLND) for rectal cancer is a vital procedure to achieve en bloc removal of metastatic lateral lymph nodes with surrounding fat tissues, guided by precise anatomical landmarks. The anatomy of the lateral compartment, however, is not straightforward for the majority of surgeons. Inadequate knowledge of the vascular and neural anatomy may increase the risk of intraoperative complications such as bleeding, nerve injury and incomplete lymph node dissection. Minimally invasive surgery provides enhanced visualization of the surgical anatomy in the lateral compartment. Comprehensive knowledge of surgical anatomy is indispensable for successful LLND, and simplifying the anatomy into the planes makes the procedure accessible for surgeons. This article presents anatomical landmarks essential for standardizing the step-by-step procedures of LLND and review the literature. i.e., for safe implementation of the procedures.
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Affiliation(s)
- T Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - T Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Sakurai T, Hiyoshi Y, Daitoku N, Matsui S, Mukai T, Nagasaki T, Yamaguchi T, Akiyoshi T, Kawachi H, Fukunaga Y. Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection. Surg Today 2025; 55:144-153. [PMID: 39196341 DOI: 10.1007/s00595-024-02905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/23/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Lateral pelvic lymph node (LPLN) metastasis of rectal neuroendocrine tumors (NETs) is rare, with unknown oncological features. We investigated the oncological impact of LPLN metastasis in patients with rectal NETs. METHODS This study included 214 patients with rectal NETs who underwent curative surgery. We evaluated their clinicopathological characteristics and short- and long-term outcomes. RESULTS LPLN dissection was performed in 15 patients with LPLN swelling ≥ 7 mm (preoperative imaging); 12 patients had LPLN metastases, 6 of whom had LPLN metastases without mesorectal lymph node metastases (skip metastasis). The short-term outcomes were similar between the groups with and without LPLN dissection. The median follow-up period was 59.4 months, and patients with LPLN metastasis showed significantly shorter disease-free and overall survival rates than those without metastasis. Among 199 patients who did not undergo LPLN dissection, only 1 had LPLN recurrence. In a univariate analysis, tumor depth, tumor grade, and LPLN metastasis were associated with the overall survival. In the multivariate analysis, only LPLN metastasis was an independent predictor of the overall survival. CONCLUSIONS LPLN metastasis is a poor prognostic factor for patients with rectal NETs. LPLN enlargement can be considered an indication for dissection, owing to its high rate of metastasis and associated poor prognosis.
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Affiliation(s)
- Tsubasa Sakurai
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
| | - Y Hiyoshi
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - N Daitoku
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - S Matsui
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - T Mukai
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - T Nagasaki
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - T Yamaguchi
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - T Akiyoshi
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - H Kawachi
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Y Fukunaga
- Department of Gastroenterological Surgery, Gastroenterological Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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Morohashi H, Sakamoto Y, Miura T, Kagiya T, Sato K, Tsutsumi S, Takahashi S, Nakayama Y, Tamba H, Matsumoto S, Kasai D, Hakamada K. Long-term outcomes of S-1 and oxaliplatin neoadjuvant chemotherapy with total mesorectal excision and lateral lymph node dissection for rectal cancer. BMC Gastroenterol 2024; 24:456. [PMID: 39695948 DOI: 10.1186/s12876-024-03549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/03/2024] [Indexed: 12/20/2024] Open
Abstract
PURPOSE Chemoradiotherapy (CRT) for rectal cancer is limited by its harmful side effects and its insufficient benefit on lateral lymph node metastases. The purpose of this study was to evaluate the long-term outcomes of S-1 and oxaliplatin with total mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiation for rectal cancer. METHODS The inclusion criteria were patients with stage II or III rectal cancer located within 10 cm from the anal verge. Fifty-two patients who underwent neoadjuvant chemotherapy (NAC) followed by TME and LLND were evaluated. The primary endpoint was the 3-year local recurrence. The secondary endpoints were the 3-year rates of relapse-free survival and overall survival. Expected post-NAC and surgical outcomes were prospectively analyzed. RESULTS The overall recurrence rate was 15.4%, with eight patients developing distant recurrences. The local recurrence rate was 7.7% (n = 4). Among the 4 patients with local recurrence, 3 (5.8%) patients had central pelvis recurrence, and 1 (1.9%) patient had lateral pelvic recurrence. The 3-year survival rate was 98.1%, and the 3-year relapse-free survival rate was 84.6%. The risk factors for local recurrence were mucinous carcinoma (p = 0.016) and a positive resection margin (p = 0.009). Pathological mesorectal lymph node metastasis and local recurrence were independent risk factors for poor survival. CONCLUSIONS Although preoperative chemotherapy and TME with LLND are sufficient to control local recurrence, some cases will require more aggressive chemotherapy with radiation therapy.
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Affiliation(s)
- Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan.
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Takuji Kagiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | | | | | | | - Hiroaki Tamba
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Shuntaro Matsumoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Daiki Kasai
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan
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Eriksen JR, Brisling SK, Gögenur I. Initial experience and results of robotic lateral pelvic lymph node dissection in locally advanced rectal cancer-a single center experience of 17 consecutive procedures. Int J Colorectal Dis 2024; 39:204. [PMID: 39688615 DOI: 10.1007/s00384-024-04782-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2024] [Indexed: 12/18/2024]
Abstract
PURPOSE We have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility. METHODS The study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment. RESULTS Out of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35-79) with a median BMI of 25.6 kg/m2 (range 19.4-34.5). The total median operation time was 335 min (range 182-526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2-14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0-11) per patient and malignant LLNs were verified in three patients (17.6%). CONCLUSION This study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.
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Affiliation(s)
- Jens Ravn Eriksen
- Department of Surgery, Colorectal cancer unit, Zealand University Hospital, Køge, Denmark and Center for Surgical Science, Zealand University Hospital, Køge, Denmark.
| | - Steffen Kirstein Brisling
- Department of Surgery, Colorectal cancer unit, Zealand University Hospital, Køge, Denmark and Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Department of Surgery, Colorectal cancer unit, Zealand University Hospital, Køge, Denmark and Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Shinto E, Ike H, Ito M, Takahashi K, Ohue M, Kanemitsu Y, Suto T, Kinugasa T, Watanabe J, Hida JI, Itabashi M, Ozawa H, Nozawa H, Hashiguchi Y, Hase K, Sugihara K, Ajioka Y. Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns. Int J Clin Oncol 2024; 29:1896-1907. [PMID: 39402391 DOI: 10.1007/s10147-024-02630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/17/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Lateral node metastasis confers a poor prognosis in rectal cancer. Several multidisciplinary treatments have been proposed with favorable outcomes. However, appropriate neoadjuvant/adjuvant treatments or follow-up plans based on information about the probable recurrence site have not been specified. We aimed to clarify the distinctive features of recurrence patterns for lateral node-positive low rectal cancer according to the lateral and mesorectal lymph node status. METHODS We retrospectively analyzed 508 patients with stage III low rectal cancer who underwent lateral node dissection. We investigated the impact of lateral and mesorectal lymph node status on site-specific recurrence rates and patient survival. RESULTS Analyses for relapse-free survival revealed the prognostic impact of lateral node positivity in stage III low rectal cancer (p < 0.0001). Lateral node-positive patients exhibited higher risk of overall recurrence, local recurrence, and recurrence in extra-regional nodes than lateral node-negative patients (p < 0.0001, p = 0.001, and p < 0.0001, respectively). However, lateral node positivity was not statistically associated with a hematogenous recurrence rate. In lateral node-positive patients, both tumor-node-metastasis (TNM)-N status and number of lateral nodes involved were revealed as significant prognostic factors (p < 0.0001, both). In addition, the number of lateral nodes involved could be a discriminatory indicator of probabilities of local recurrence and recurrence in extra-regional nodes (p = 0.02, and p < 0.0001, respectively). CONCLUSIONS Lateral node-positive low rectal cancer exhibits higher local recurrence and extra-regional node recurrence rates that correlate with the number of lateral nodes involved.
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Affiliation(s)
- Eiji Shinto
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan.
| | - Hideyuki Ike
- Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, 43-1 Kamadai, Hodogaya, Yokohama, Kanagawa, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki, Shinjyuku, Tokyo, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo, Osaka, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, Japan
| | - Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan
| | | | - Jun Watanabe
- Department of Colorectal Surgery, Kansai Medical University, 5-1 Shinmachi 2 Chome, Hirakata, Osaka, Japan
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University Nara Hospital, Otoda, Ikoma, Nara, 1248-1, Japan
| | - Michio Itabashi
- Saiseikai Kazo Hospital, Kamitakayanagi, Kazo, Saitama, 1680, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota, Tokyo, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Japan
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Dantas PP, Teixeira VB, Marques CFS, Nogueira GF, Ortega CD. Roles of MRI evaluation of pelvic recurrence in patients with rectal cancer. Insights Imaging 2024; 15:270. [PMID: 39527151 PMCID: PMC11554996 DOI: 10.1186/s13244-024-01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 10/05/2024] [Indexed: 11/16/2024] Open
Abstract
Developments in the multidisciplinary treatment of rectal cancer with advances in preoperative magnetic resonance imaging (MRI), surgical techniques, neoadjuvant chemoradiotherapy, and adjuvant chemotherapy have had a significant impact on patient outcomes, increasing the rates of curative surgeries and reducing pelvic recurrence. Patients with pelvic recurrence have worse prognoses, with an impact on morbidity and mortality. Although local recurrence is more frequent within 2 years of surgical resection of the primary tumor, late recurrence may occur. Clinical manifestations can vary from asymptomatic, nonspecific symptoms, to pelvic pain, bleeding, and fistulas. Synchronous metastatic disease occurs in approximately 50% of patients diagnosed with local recurrence. MRI plays a crucial role in posttreatment follow-up, whether by identifying viable neoplastic tissues or acting as a tool for therapeutic planning and assessing the resectability of these lesions. Locally recurrent tissues usually have a higher signal intensity than muscle on T2-weighted imaging. Thus, attention is required for focal heterogeneous lesions, marked contrast enhancement, early invasive behavior, and asymmetric appearance, which are suspicious for local recurrence. However, postsurgical inflammatory changes related to radiotherapy and fibrosis make it difficult to detect initial lesions. This study therefore aimed to review the main imaging patterns of pelvic recurrence and their implications for the surgical decision-making process. CRITICAL RELEVANCE STATEMENT: MRI plays a crucial role in the posttreatment follow-up of rectal cancer, whether by identifying viable neoplastic tissues or by acting as a tool for therapeutic planning. This study reviewed the main imaging patterns of pelvic recurrence. KEY POINTS: MRI aids in surgical planning and the detection of pelvic recurrence and postoperative complications. Being familiar with surgical techniques enables radiologists to identify expected MRI findings. Patterns of rectal cancer recurrence have been categorized by pelvic compartments. Neoplastic tissue may mimic postsurgical and postradiotherapy changes. Resectability of pelvic recurrence is highly related to lesion location.
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Affiliation(s)
- Patricia Perola Dantas
- Instituto do Cancer do Estado de São Paulo do Hospital das Clinicas ICESP/HCFMUSP, Department of Radiology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil.
| | - Verônica Botelho Teixeira
- Instituto do Cancer do Estado de São Paulo do Hospital das Clinicas ICESP/HCFMUSP, Department of Radiology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Carlos Frederico Sparapan Marques
- Colorectal Division, Instituto do Cancer do Estado de São Paulo do Hospital das Clinicas ICESP/HCFMUSP, Department of Gastroenterology and Nutrology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Gerda Feitosa Nogueira
- Instituto do Cancer do Estado de São Paulo do Hospital das Clinicas ICESP/HCFMUSP, Department of Radiology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Cinthia D Ortega
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Department of Radiology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
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11
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Curcean S, Curcean A, Martin D, Fekete Z, Irimie A, Muntean AS, Caraiani C. The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer. Cancers (Basel) 2024; 16:3111. [PMID: 39272969 PMCID: PMC11394290 DOI: 10.3390/cancers16173111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
The role of magnetic resonance imaging (MRI) in rectal cancer management has significantly increased over the last decade, in line with more personalized treatment approaches. Total neoadjuvant treatment (TNT) plays a pivotal role in the shift from traditional surgical approach to non-surgical approaches such as 'watch-and-wait'. MRI plays a central role in this evolving landscape, providing essential morphological and functional data that support clinical decision-making. Key MRI-based biomarkers, including circumferential resection margin (CRM), extramural venous invasion (EMVI), tumour deposits, diffusion-weighted imaging (DWI), and MRI tumour regression grade (mrTRG), have proven valuable for staging, response assessment, and patient prognosis. Functional imaging techniques, such as dynamic contrast-enhanced MRI (DCE-MRI), alongside emerging biomarkers derived from radiomics and artificial intelligence (AI) have the potential to transform rectal cancer management offering data that enhance T and N staging, histopathological characterization, prediction of treatment response, recurrence detection, and identification of genomic features. This review outlines validated morphological and functional MRI-derived biomarkers with both prognostic and predictive significance, while also exploring the potential of radiomics and artificial intelligence in rectal cancer management. Furthermore, we discuss the role of rectal MRI in the 'watch-and-wait' approach, highlighting important practical aspects in selecting patients for non-surgical management.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Andra Curcean
- Department of Imaging, Affidea Center, 15c Ciresilor Street, 400487 Cluj-Napoca, Romania
| | - Daniela Martin
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Zsolt Fekete
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alexandru Irimie
- Department of Oncological Surgery and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Oncological Surgery, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alina-Simona Muntean
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Medical Imaging and Nuclear Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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12
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Hoshino N, Fukui Y, Ueno K, Hida K, Obama K, Sakamoto K, Kobayashi H, Itabashi M, Ishihara S, Kawai K, Ajioka Y. Identification of lateral pelvic nodes without metastasis in patients with rectal cancer treated with preoperative chemoradiotherapy or chemotherapy based on magnetic resonance imaging. Ann Gastroenterol Surg 2024; 8:732-739. [PMID: 39229550 PMCID: PMC11368503 DOI: 10.1002/ags3.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/05/2024] [Accepted: 04/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background Intensive localized therapy is promising for the treatment of rectal cancer. In Japan, chemoradiotherapy (CRT) and neoadjuvant chemotherapy (NAC) are used as preoperative treatments for this disease. Magnetic resonance imaging (MRI) is used to diagnose lateral pelvic node (LPN) metastases, but the changes in LPN findings on MRI following preoperative treatment are unclear. Furthermore, there may be patients in whom LPN dissection can be omitted after CRT/NAC. Methods Patients who underwent total mesorectal excision with LPN dissection after CRT/NAC at 13 Japanese Society for Cancer of the Colon and Rectum member institutions between 2017 and 2019 were included. Changes in the short diameter of the LPNs after CRT/NAC and the reduction rate were examined. Results A total of 101 LPNs were examined in 28 patients who received CRT and 228 in 47 patients who received NAC. Comparison of LPNs before and after CRT/NAC showed that most LPNs shrank after CRT but that the size reduction was variable after NAC. Although some LPNs with a short diameter of <5 mm showed residual metastasis, no metastases were observed in LPNs that were <5 mm in short diameter before and after CRT/NAC and did not shrink after treatment. Conclusion Although the short diameter of LPNs was significantly reduced by both CRT and NAC, even LPNs with a short diameter of <5 mm could have residual metastases. However, dissection may be omitted for LPNs <5 mm in short diameter that do not shrink after preoperative CRT or NAC.
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Affiliation(s)
- Nobuaki Hoshino
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Yudai Fukui
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Kohei Ueno
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Kazutaka Obama
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | | | - Michio Itabashi
- Department of Surgery Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | | | - Kazushige Kawai
- Department of Colorectal SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
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13
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Tanaka Y, Hino H, Shiomi A, Uehara K, Watanabe J, Nishikawa T, Ueno H, Kinugasa Y, Kawai K, Ajioka Y. Efficacy of lateral lymph node dissection for local control of rectal cancer: A multicenter study. Ann Gastroenterol Surg 2024; 8:631-638. [PMID: 38957561 PMCID: PMC11216789 DOI: 10.1002/ags3.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 07/04/2024] Open
Abstract
Background This study aimed to evaluate the efficacy of lateral lymph node dissection (LLND) for rectal cancer by comparing the local control in patients with and without pathological lateral lymph node metastasis (LLNM). Methods We included 189 patients with rectal cancer who underwent total mesorectal excision and LLND at 13 institutions between 2017 and 2019. Patients with and without pathological LLNM were defined as the pLLNM (+) and (-) groups, respectively. Propensity score-matching helped to balance the basic characteristics of both groups. The incidences of local recurrence (LR) and lateral lymph node recurrence (LLNR) were compared between the groups. Results In the entire cohort, 39 of the 189 patients had pathological LLNM. The 3-year LR and LLNR rates were 18.3% and 4.0% (p = 0.01) and 7.7% and 3.3% (p = 0.22) in the pLLNM (+) and (-) groups, respectively. After propensity score matching, the data from 62 patients were analyzed. No significant differences in LR or LLNR were observed between both groups. The 3-year LR and LLNR rates were 16.4% and 9.8% (p = 0.46) and 9.7% and 9.8% (p = 0.99) in the pLLNM (+) and (-) groups, respectively. Conclusion LLND would lead to comparable local control in the pLLNM (+) and (-) groups if the clinicopathological characteristics except for LLNM are similar.
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Affiliation(s)
- Yusuke Tanaka
- Division of Colon and Rectal SurgeryShizuoka Cancer Center HospitalSunto‐gunJapan
| | - Hitoshi Hino
- Division of Colon and Rectal SurgeryShizuoka Cancer Center HospitalSunto‐gunJapan
| | - Akio Shiomi
- Division of Colon and Rectal SurgeryShizuoka Cancer Center HospitalSunto‐gunJapan
| | - Kay Uehara
- Division of Gastrointestinal and Hepato‐Biliary Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Takeshi Nishikawa
- Division of Gastroenterological SurgerySaitama Cancer CenterInaJapan
| | - Hideki Ueno
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Kazushige Kawai
- Department of Colorectal SurgeryTokyo Metropolitan Cancer and Infectious Disease Center Komagome HospitalTokyoJapan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental ScienceNiigata UniversityNiigataJapan
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14
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Li C, Luan J, Ji X, Wang X, Li J, Li X, Zhou Y. The influence of neoadjuvant chemoradiotherapy combined with lateral lymph nodes dissection or not on the local recurrence of low to intermediate-stage II/III rectal cancer. J Surg Oncol 2024; 129:273-283. [PMID: 37811551 DOI: 10.1002/jso.27471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Currently, the treatment options for stage II/III rectal cancer with preoperative lateral lymph nodes (LLN) enlargement are highly controversial between East and West, and the indications for diagnosing suspiciously positive enlarged LLN are inconsistent both nationally and internationally. Oriental scholars (especially Japanese) consider the LLN as a regional disease, they consider that prophylactic lateral lymph nodes dissection (LLND), regardless of whether the LLN is enlarged or not, is considered necessary if the tumor is found beneath the peritoneal reflex and invades the muscle layer. Western scholars regard LLN as distant metastases, recommending neoadjuvant chemoradiotherapy (nCRT) in conjunction with total rectal mesenteric resection (TME). In recent years, it has been found that neither of the two standard treatment regimens, East and West, significantly improved local control of tumors in patients with LLN enlargement. In contrast, nCRT combined with LLND significantly lowers the local recurrence (LR) rate. It has also been suggested that combination therapy regimens do not improve patient prognosis but increase treatment-related complications. Therefore, the suitable therapeutic option for rectal cancer with an enlarged LLN needs to be further explored. AIM Exploring appropriate treatment options for low to intermediate-stage II/III rectal cancer with LLN enlargement, as well as risk variables that may affect the LR in these patients with LLN enlarged. METHODS AND PATIENTS In this research, we retrospectively analyzed 110 patients with locally advanced mid-low (low boundary of tumor is no more than 10 cm from the anus) rectal cancer who were treated at Harbin Medical University Cancer Hospital arranged from 2017.1 to 2020.6. These patients had received nCRT and TME, and their initial rectal nuclear magnetic resonance imaging (MRI) revealed an enlarged LLN (short axis of LLN, SA ≥ 5 mm). Of these, 40 patients underwent LLND, thus, 110 patients were grouped into two groups: nCRT+TME (LLND-, n = 70) and nCRT+TME + LLND (LLND+, n = 40), and their 3 years prognoses were compared. RESULTS After a median follow-up of 49.0 months, the 3-year LR rate of the LLND- group was notably greater than the LLND+ group (22.8% vs. 7.5%, p = 0.04). However, there was no noteworthy difference in the 3-year progression-free survival (PFS, 70.5% vs. 77.5%, p > 0.05) rate or distant metastasis (DM) rate (20.0% vs. 17.5%, p > 0.05). Additionally, the LLND+ group experienced significantly more postoperative complications than the LLND- group (15.0% vs. 4.2%, p = 0.05). Subgroups analysis for the LLND- group revealed that patients with LLN short axis regression (ΔSA) > 35.9% after nCRT had significantly lower 3-year LR rate than patients with ΔSA ≤ 35.9% (9.1% vs. 35.1%, p = 0.01). Patients in the LLND- group with ΔSA > 35.9%, however, had comparable 3-year LR rate and DM rates to those in the LLND+ group. CONCLUSION LLN is an independent indicator for prognosis among people with low to intermediate-stage II/III malignant rectal tumors. Patients with poor SA regression (ΔSA ≤ 35.9%) after nCRT have a greater risk of positive LLN and a more substantial LR, and nCRT combined with LLND reduced the LR rate significantly, but considerably prolonged operative time, surgical bleeding, and postoperative complications. Patients with better SA regression (ΔSA > 35.9%), however, have a lower possibility of LR and might not need LLN clearance, in these cases, nCRT+TME is advised.
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Affiliation(s)
- Chunying Li
- Department of Abdominal Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jinwei Luan
- Department of Abdominal Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Ji
- Department of Abdominal Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiaqi Li
- Department of Abdominal Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xianglan Li
- Department of Abdominal Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China
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15
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Zhou S, Zhang H, Liang J, Fu W, Lou Z, Feng B, Yang Y, Xie Z, Liu Q. Feasibility, Indications, and Prognostic Significance of Selective Lateral Pelvic Lymph Node Dissection After Preoperative Chemoradiotherapy in Middle/Low Rectal Cancer: Results of a Multicenter Lateral Node Study in China. Dis Colon Rectum 2024; 67:228-239. [PMID: 36649192 DOI: 10.1097/dcr.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lateral pelvic lymph node dissection after preoperative chemoradiotherapy can decrease local recurrence to lateral compartments, thereby providing survival benefits. OBJECTIVE The safety of lateral pelvic lymph node dissection after preoperative chemoradiotherapy was investigated, and the surgical indications and survival benefits of lateral pelvic lymph node dissection were established on the basis of preoperative characteristics. DESIGN A multicenter retrospective study. SETTINGS Three hospitals in China. PATIENTS Four hundred nine patients with clinical evidence of lateral pelvic lymph node metastasis. INTERVENTIONS Patients who received lateral pelvic lymph node dissection were divided into 2 groups depending on whether they received chemoradiotherapy (n = 139) or not (n = 270). MAIN OUTCOME MEASURES The safety, indications, and survival benefits of lateral pelvic lymph node dissection after preoperative chemoradiotherapy were investigated. RESULTS The surgery times were significantly prolonged by preoperative chemoradiotherapy (291.3 vs 265.5 min; p = 0.021). Multivariate analysis demonstrated that poor/mucinous/signet-ring adenocarcinoma (OR = 4.42, 95% CI, 2.24-11.27; p = 0.031) and postchemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm (OR = 15.2, 95% CI, 5.89-53.01; p < 0.001) were independent predictive factors for lateral pelvic lymph node metastasis. Multivariate prognostic analysis showed that swollen lateral pelvic lymph nodes beyond the obturator or internal iliac as well as the involvement of 3 or more lateral pelvic lymph nodes were independent adverse prognostic factors. LIMITATIONS The retrospective nature of the study and the small sample size were the limitations of this study. CONCLUSIONS Preoperative chemoradiotherapy combined with lateral pelvic lymph node dissection is a practicable procedure with acceptable morbidity. Postchemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm and poor/signet/mucinous adenocarcinoma could be used for predicting lateral pelvic lymph node metastasis after chemoradiotherapy. However, lateral pelvic lymph node dissection should be carefully considered in patients with swollen lateral pelvic lymph nodes beyond the obturator or internal iliac region or involvement of multiple lateral pelvic lymph nodes. See Video Abstract at http://links.lww.com/DCR/C133 . VIABILIDAD, INDICACIONES E IMPORTANCIA PRONSTICA DE LA DISECCIN SELECTIVA DE GANGLIOS LINFTICOS PLVICOS LATERALES DESPUS DE QUIMIORRADIOTERAPIA PREOPERATORIA EN CNCER DE RECTO MEDIO/INFERIOR RESULTADOS DE UN ESTUDIO MULTICNTRICO DE GANGLIOS LATERALES EN CHINA ANTECEDENTES:La disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria puede disminuir la recurrencia local en los compartimentos laterales, lo que brinda beneficios de supervivencia.OBJETIVO:Se investigó la seguridad de la disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria, y se establecieron las indicaciones quirúrgicas y los beneficios de supervivencia de la disección de los ganglios linfáticos pélvicos laterales en función de las características preoperatorias.DISEÑO:Estudio retrospectivo multicéntrico.ESCENARIO:Tres hospitales en China.PACIENTES:Cuatrocientos nueve pacientes con evidencia clínica de metástasis en los ganglios linfáticos pélvicos laterales.INTERVENCIONES:Los pacientes que recibieron disección de ganglios linfáticos pélvicos laterales se dividieron en dos grupos dependiendo de si recibieron quimiorradioterapia (n = 139) o no (n = 270).PRINCIPALES MEDIDAS DE RESULTADO:Se investigaron la seguridad, las indicaciones y los beneficios de supervivencia de la disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria.RESULTADOS:Los tiempos de cirugía se prolongaron significativamente con la quimiorradioterapia preoperatoria (291,3 vs 265,5 min, p = 0,021). El análisis multivariable demostró que el adenocarcinoma mal diferenciado/mucinoso/en anillo de sello (odds ratio = 4,42, intervalo de confianza del 95%, 2,24-11,27; p = 0,031) y el diámetro del eje corto de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia ≥7 mm (odds ratio = 15,2, intervalo de confianza del 95%, 5,89-53,01; p < 0,001) fueron factores predictivos independientes de metástasis en los ganglios linfáticos pélvicos laterales. El análisis pronóstico multivariable mostró que la inflamación de los ganglios linfáticos pélvicos laterales más allá del obturador o la ilíaca interna, así como la afectación de tres o más ganglios linfáticos pélvicos laterales, eran factores pronósticos adversos independientes.LIMITACIONES:La naturaleza retrospectiva del estudio y el pequeño tamaño de la muestra.CONCLUSIONES:La quimiorradioterapia preoperatoria combinada con la disección de los ganglios linfáticos pélvicos laterales es un procedimiento practicable con una morbilidad aceptable. Posterior a la quimiorradioterapia, el diámetro del eje corto de los ganglios linfáticos pélvicos laterales ≥7 mm y el adenocarcinoma pobre/en sello/mucinoso podrían usarse para predecir la metástasis en los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia. Sin embargo, la disección de los ganglios linfáticos pélvicos laterales debe considerarse cuidadosamente en pacientes con ganglios linfáticos pélvicos laterales inflamados más allá del obturador o de la región ilíaca interna o compromiso de múltiples ganglios linfáticos pélvicos laterales. Consulte Video Resumen en http://links.lww.com/DCR/C133 . (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Sicheng Zhou
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Colorectal Tumor Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Fu
- Department of Gastrointestinal Surgery, Affiliated Hospital, Xuzhou Medical College, Xuzhou, China
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, Nava Military Medical University, Shanghai, China
| | - Bo Feng
- Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Yingchi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongshi Xie
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Chua JYJ, Ngu JCY, Teo NZ. Current perspectives on the management of lateral pelvic lymph nodes in rectal cancer. World J Clin Oncol 2023; 14:584-592. [PMID: 38179407 PMCID: PMC10762530 DOI: 10.5306/wjco.v14.i12.584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/22/2023] Open
Abstract
Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases (mLLN) in patients with low rectal cancer. The differing views held by Japanese and Western clinicians on the management of mLLN have been well documented. However, the adequacy of pelvic lymph node dissection (PLND) or neoadjuvant chemoradiation (NACRT) alone in addition to total mesorectal excision (TME) have recently come into question, due to the relatively high incidence of lateral local recurrences following PLND and TME, or NACRT and TME alone. Recently, a more selective approach to PLND has been suggested, involving a combination of neoadjuvant therapy, followed by PLND only to patients in whom the oncological benefit is likely to outweigh the risk of potential adverse events. A number of studies have attempted to retrospectively identify certain nodal characteristics on preoperative imaging, such as nodal size, appearance, and size reduction following neoadjuvant therapy. However, no consensus has been reached regarding the optimal criteria for a selective approach to PLND, partly due to the heterogeneity and retrospective nature of most of these studies. This review aims to provide an overview of recent evidence with regards to the diagnostic challenges, considerations for, and outcomes of the current management strategies for mLLN in rectal cancer patients.
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Affiliation(s)
- Jonathan Yu Jin Chua
- Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - James Chi Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Nan Zun Teo
- Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
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17
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Liu Y, Bao M, Jiang Y, Li F, Xing W, Yang Z, Liu Q. Optimization of therapeutic strategies for selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in patients with rectal cancer with clinical suspected lateral lymph node metastasis. Front Oncol 2023; 13:1271463. [PMID: 37886180 PMCID: PMC10598648 DOI: 10.3389/fonc.2023.1271463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
Background Selective lateral lymph node (LLN) dissection with total mesorectal excision after neoadjuvant chemoradiotherapy (nCRT) is pointed out to reduce lateral compartment recurrence and to improve survival in patients with rectal cancer with LLN metastases. This study aimed to explore the safety, surgical indications, and survival outcomes of LLN dissection after nCRT. Methods This multicenter retrospective study included patients with rectal cancer with clinical evidence of LLN metastases (n = 466) treated across three hospitals in China. Patients who underwent total mesorectal excision and LLN dissection were grouped into nCRT (n = 155) and non-nCRT (n = 291), respectively. Propensity score matching was used to minimize selection bias. Results After matching, nCRT did not significantly increase the surgery duration, intraoperative blood loss or postoperative complications (P > 0.05). In a multivariate logistic regression analysis, poor/mucinous/signet adenocarcinoma (P = 0.042) and post-nCRT LLN short diameter ≥7 mm (P < 0.001) were independent risk factors for pathological LLN metastasis after nCRT. Overall survival (P < 0.001) and disease-free survival (P < 0.001) were significantly worse in patients with LLN metastasis, which was, however, not an independent risk factor for survival after eliminating confounders. Multivariate prognostic analysis of 40-patient subset with pathological LLN metastasis showed that distant metastasis, metastasis beyond the obturator or internal iliac region, and ≥2 LLN metastasis were independent predictors of poor overall survival. Conclusions Selective LLN dissection after nCRT is safe and feasible with acceptable perioperative outcomes. Patients with a post-nCRT LLN short diameter ≥7 mm or poor/mucinous/signet adenocarcinoma should receive supplementary LLN dissection after nCRT. However, patients with distant metastasis, metastasis beyond the obturator or internal iliac region, and involvement of ≥2 LLN may not benefit from LLN dissection, and LLN dissection should be carefully considered in such patients.
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Affiliation(s)
- Yuan Liu
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Mandoula Bao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Wei Xing
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhufeng Yang
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Antonisse IE, Berbée M, van Bockel LW, Boer AH, Ceha HM, Cnossen JS, Geijsen ED, den Hartogh MD, Hendriksen EM, Intven MPW, Leseman-Hoogenboom MM, Meijnen P, Muller K, Oppedijk V, Rozema T, Rütten H, Spruit PH, Stam TC, Velema LA, Verrijssen ASE, Vos-Westerman J, Tanis PJ, Marijnen CAM, Kusters M. Coverage of Lateral Lymph Nodes in Rectal Cancer Patients with Routine Radiation Therapy Practice and Associated Locoregional Recurrence Rates. Int J Radiat Oncol Biol Phys 2023; 117:422-433. [PMID: 37120027 DOI: 10.1016/j.ijrobp.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Involved internal iliac and obturator lateral lymph nodes (LLNs) are a known risk factor for the occurrence of ipsilateral local recurrences (LLR) in rectal cancer. This study examined coverage of LLNs with routine radiation therapy practice in the Netherlands and associated LLR rates. METHODS AND MATERIALS Patients with a primary tumor ≤8 cm of the anorectal junction, cT3-4 stage, and at least 1 internal iliac or obturator LLN with short axis ≥5 mm who received neoadjuvant (chemo)radiation therapy, were selected from a national, cross-sectional study of patients with rectal cancer treated in the Netherlands in 2016. Magnetic resonance images and radiation therapy treatment plans were reviewed regarding segmented LLNs as gross tumor volume (GTV), location of LLNs within clinical target volume (CTV), and received proportion of the planned radiation therapy dose. RESULTS A total of 223 out of 3057 patients with at least 1 LLN ≥5 mm were selected. Of those, 180 (80.7%) LLNs were inside the CTV, of which 60 (33.3%) were segmented as GTV. Overall, 202 LLNs (90.6%) received ≥95% of the planned dose. Four-year LLR rates were not significantly higher for LLNs situated outside the CTV compared with those inside (4.0% vs 12.5%, P = .092) or when receiving <95% versus ≥95% of the planned radiation therapy dose (7.1% vs 11.3%, P = .843), respectively. Two of 7 patients who received a dose escalation of 60 Gy developed an LLR (4-year LLR rate of 28.6%). CONCLUSIONS This evaluation of routine radiation therapy practice showed that adequate coverage of LLNs was still associated with considerable 4-year LLR rates. Techniques resulting in better local control for patients with involved LLNs need to be explored further.
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Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life, Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life, Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Department of Radiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Imogeen E Antonisse
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Anniek H Boer
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Heleen M Ceha
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Jeltsje S Cnossen
- Department of Radiation Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Elisabeth D Geijsen
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Ellen M Hendriksen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Martijn P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Philip Meijnen
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Karin Muller
- Radiotherapiegroep, Arnhem/Deventer, the Netherlands
| | - Vera Oppedijk
- Department of Radiation Oncology, Radiation Therapy Institute Friesland, Leeuwarden, the Netherlands
| | - Tom Rozema
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Patty H Spruit
- Department of Radiation Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Tanja C Stam
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Laura A Velema
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - An-Sofie E Verrijssen
- Department of Radiation Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands
| | | | - Pieter J Tanis
- Treatment and Quality of Life, Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life, Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Watanabe J, Ohya H, Sakai J, Suwa Y, Goto K, Nakagawa K, Ozawa M, Ishibe A, Suwa H, Kunisaki C, Endo I. Long-term outcomes of indocyanine green fluorescence imaging-guided laparoscopic lateral pelvic lymph node dissection for clinical stage II/III middle-lower rectal cancer: a propensity score-matched cohort study. Tech Coloproctol 2023; 27:759-767. [PMID: 36773172 DOI: 10.1007/s10151-023-02761-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND We previously reported that indocyanine green fluorescence imaging (ICG-FI)-guided laparoscopic lateral pelvic lymph node dissection (LPLND) was able to increase the total number of harvested lateral pelvic lymph nodes without impairing functional preservation. However, the long-term outcomes of ICG-FI-guided laparoscopic LPLND have not been evaluated. The aim of the present study was to compare the long-term outcomes of ICG-FI-guided laparoscopic LPLND to conventional laparoscopic LPLND without ICG-FI. METHODS This was a retrospective, multi-institutional study with propensity score matching. The study population included consecutive patients with middle-low rectal cancer (clinical stage II to III) who underwent laparoscopic LPLND between January 2013 and February 2018. The main evaluation items in this study were the 3-year overall survival, relapse-free survival (RFS), local recurrence rate, and lateral local recurrence (LLR) rate. RESULTS A total of 172 patients with middle-lower rectal cancer who had undergone laparoscopic LPLND were included in this study. After propensity score matching, 58 patients were matched in each of the ICG-FI and non-ICG-FI groups. There were no substantial differences in the baseline characteristics between the two groups. The ICG-FI group and non-ICG-FI group included 40 and 38 women and had a median age of 65 (IQR 60-72) and 66 (IQR 60-73) years, respectively. The median follow-up for all patients was 63.7 (IQR 51.3-76.8) months. The estimated respective 3-year overall survival, RFS, and local recurrence rates were 93.1%, 70.7%, and 5.2% in the ICG-FI group and 85.9%, 71.7%, and 12.8% in the non-ICG-FI group (p = 0.201, 0.653, 0.391). The 3-year cumulative LLR rate was 0% in the ICG-FI group and 9.3% in the non-ICG-FI group (p = 0.048). CONCLUSIONS This study revealed that laparoscopic LPLND combined with ICG-FI was able to decrease the LLR rate. It appears that ICG-FI could contribute to improving the quality of laparoscopic LPLND and strengthening local control of the lateral pelvis. TRIALS REGISTRATION This study was registered with the Japanese Clinical Trials Registry as UMIN000041372 ( http://www.umin.ac.jp/ctr/index.htm ).
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Affiliation(s)
- J Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - H Ohya
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - J Sakai
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Y Suwa
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - K Goto
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - K Nakagawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - M Ozawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - A Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - H Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - C Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - I Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Zhao W, Wang ZJ, Mei SW, Chen JN, Zhou SC, Zhao FQ, Xiao TX, Huang F, Liu Q. Fascia- vs vessel-oriented lateral lymph node dissection for rectal cancer: Short-term outcomes and prognosis in a single-center experience. World J Gastrointest Surg 2023; 15:1080-1092. [PMID: 37405106 PMCID: PMC10315111 DOI: 10.4240/wjgs.v15.i6.1080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/02/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND For the management of lateral lymph node (LLN) metastasis in patients with rectal cancer, selective LLN dissection (LLND) is gradually being accepted by Chinese scholars. Theoretically, fascia-oriented LLND allows radical tumor resection and protects of organ function. However, there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND. Through a preliminary study with a small sample size, we found that fascia-oriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs. In this study, we increased the sample size and refined the postoperative functional outcomes.
AIM To compare the effects of fascia- and vessel-oriented LLND regarding short-term outcomes and prognosis.
METHODS We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021. The short-term outcomes included perioperative outcomes and postoperative functional outcomes. The prognosis was measured based on overall survival (OS) and progression-free survival (PFS).
RESULTS A total of 105 patients were included in the final analysis and were divided into fascia- and vessel-oriented groups that included 41 and 64 patients, respectively. Regarding the short-term outcomes, the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group. There were no significant differences in the other short-term outcomes. The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group. In addition, there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups. In terms of prognosis, there was no significant difference in PFS or OS between the two groups.
CONCLUSION It is safe and feasible to perform fascia-oriented LLND. Compared with vessel-oriented LLND, fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.
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Affiliation(s)
- Wei Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhi-Jie Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shi-Wen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jia-Nan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Si-Cheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Qiang Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ti-Xian Xiao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fei Huang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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21
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Chang G, Halabi WJ, Ali F. Management of lateral pelvic lymph nodes in rectal cancer. J Surg Oncol 2023; 127:1264-1270. [PMID: 37222691 DOI: 10.1002/jso.27317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023]
Abstract
Lateral pelvic lymph node (LPLN) involvement occurs in 10%-25% of rectal cancer cases. Total mesorectal excision (TME) with routine LPLN dissection (LPLND) is predominantly applied in Japan whereas TME with neoadjuvant treatment are used in the West. LPLND is a morbid procedure and minimally invasive techniques may help reduce its morbidity. Selective lateral pelvic node dissection with TME following neoadjuvant treatment achieves acceptable disease-free and overall survival.
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Affiliation(s)
- Gloria Chang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wissam J Halabi
- Department of Surgery, Enloe Medical Center, Chico, California, USA
| | - Fadwa Ali
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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22
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Ishizaki T, Mazaki J, Kasahara K, Udo R, Tago T, Nagakawa Y. Robotic versus laparoscopic approach for minimally invasive lateral pelvic lymph node dissection of advanced lower rectal cancer: a retrospective study comparing short-term outcomes. Tech Coloproctol 2023:10.1007/s10151-023-02818-x. [PMID: 37157049 DOI: 10.1007/s10151-023-02818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The importance of lateral pelvic lymph node dissection (LLND) for advanced low rectal cancer is gradually being recognized in Europe and the USA, where some patients were affected by uncontrolled lateral pelvic lymph node (LLNs) metastasis, even after total mesorectal excision (TME) with neoadjuvant chemoradiotherapy (CRT). The purpose of this study was thus to compare robotic LLND (R-LLND) with laparoscopic (L-LLND) to clarify the safety and advantages of R-LLND. METHODS Sixty patients were included in this single-institution retrospective study between January 2013 and July 2022. We compared the short-term outcomes of 27 patients who underwent R-LLND and 33 patients who underwent L-LLND. RESULTS En bloc LLND was performed in significantly more patients in the R-LLND than in the L-LLND group (48.1% vs. 15.2%; p = 0.006). The numbers of LLNs on the distal side of the internal iliac region (LN 263D) harvested were significantly higher in the R-LLND than in the L-LLND group (2 [0-9] vs. 1 [0-6]; p = 0.023). The total operative time was significantly longer in the R-LLND than in the L-LLND group (587 [460-876] vs. 544 [398-859]; p = 0.003); however, the LLND time was not significantly different between groups (p = 0.718). Postoperative complications were not significantly different between the two groups. CONCLUSION The present study clarified the safety and technical feasibility of R-LLND with respect to L-LLND. Our findings suggest that the robotic approach offers a key advantage, allowing significantly more LLNs to be harvested from the distal side of the internal iliac region (LN 263D). Prospective clinical trials examining the oncological superiority of R-LLND are thus necessary in the near future.
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Affiliation(s)
- Tetsuo Ishizaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
| | - Junichi Mazaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Kenta Kasahara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Ryutaro Udo
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Tomoya Tago
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
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Umeda Y, Takagi K, Matsuda T, Fuji T, Kojima T, Satoh D, Hioki M, Endo Y, Inagaki M, Oishi M, Yagi T, Fujiwara T. Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index. Ann Gastroenterol Surg 2023; 7:512-522. [PMID: 37152772 PMCID: PMC10154828 DOI: 10.1002/ags3.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Aims Lymph node metastases (LNM) are associated with lethal prognosis in intrahepatic cholangiocarcinoma (ICC). Lymphadenectomy is crucial for accurate staging and hopes of possible oncological treatment. However, the therapeutic implications and optimal extent of lymphadenectomy remain contentious. Methods To clarify the prognostic value and optimal extent of lymphadenectomy, the therapeutic index (TI) for each lymph node was analyzed for 279 cases that had undergone lymphadenectomy in a multi-institutional database. Tumor localization was divided into hilar lesions (n = 130), right peripheral lesions (n = 60), and left peripheral lesions (n = 89). In addition, the lymph node station was classified as Level 1 (LV1: hepatoduodenal ligament node), Level 2 (LV2: postpancreatic or common hepatic artery nodes), or Level 3 (LV3: gastrocardiac, left gastric artery, or celiac artery nodes). Results Lymph node metastases were confirmed in 109 patients (39%). Five-y survival rates were 45.3% for N0 disease, 27.1% for LV1-LNM, 22.9% for LV2-LNM, and 7.3% for LV3-LNM (P < 0.001). LV3-LNM were the most frequent and earliest recurrence outcome, including multisite recurrence, followed by LV2, LV1, and N0 disease. The 5-year TI (5year-TI) for lymphadenectomy was 7.2 for LV1, 5.5 for LV2, and 1.9 for LV3. Regarding tumor location, hilar lesions showed 5-year TI >5.0 in LV1 and LV2, whereas bilateral peripheral lesions showed 5-year TI > 5.0 in LV1. Conclusion The implications and extent of lymphadenectomy for ICC appear to rely on tumor location. In the peripheral type, the benefit of lymphadenectomy would be limited and dissection beyond LV1 should be avoided, while in the hilar type, lymphadenectomy up to LV2 could be recommended.
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Affiliation(s)
- Yuzo Umeda
- Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Kosei Takagi
- Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Tatsuo Matsuda
- Department of SurgeryTenwakai Matsuda HospitalKurashikiJapan
| | - Tomokazu Fuji
- Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Toru Kojima
- Department of SurgeryOkayama Saiseikai General HospitalOkayamaJapan
| | - Daisuke Satoh
- Department of SurgeryHiroshima Citizens HospitalHiroshimaJapan
| | | | | | - Masaru Inagaki
- Department of SurgeryNational Hospital Organization Fukuyama Medical CenterFukuyamaJapan
| | - Masahiro Oishi
- Department of SurgeryTottori Municipal HospitalTottoriJapan
| | - Takahito Yagi
- Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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Takemasa I, Hamabe A, Miyo M, Akizuki E, Okuya K. Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment. Ann Gastroenterol Surg 2023; 7:198-215. [PMID: 36998300 PMCID: PMC10043777 DOI: 10.1002/ags3.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard-of-care to the latest findings to help optimize treatment strategy.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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25
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Abstract
BACKGROUND Although the middle rectal artery is a relevant anatomical landmark for rectal resection and lateral lymph node dissection, descriptions of this entity are highly divergent. OBJECTIVE Dissection, visualization, morphometry, and 3-dimensional reconstruction of the middle rectal artery to facilitate its management in surgery. DESIGN Macroscopic dissection, histologic study, morphometric measurements, and virtual modeling. SETTING University laboratory of applied surgical anatomy. PATIENTS This study includes formalin-fixed hemipelvis specimens (n=37) obtained from body donors (age, 67-97 y). MAIN OUTCOME MEASURES The main outcome measures are photo documentation of origin, trajectory, diameter, and branching pattern; immunolabeling of lymphatics; and 3-dimensional reconstruction of the middle rectal artery. RESULTS The middle rectal artery was present in 71.4% of body donors (21.4% bilateral, 50% unilateral), originated from the anterior division of the internal iliac artery, and branched either from the internal pudendal artery (45.5%), the inferior gluteal artery (22.7%), the gluteal-pudendal trunk (22.7%), or a trifurcation (9.1%). One to 3 branches of varying diameters (0.5-3.5 mm) entered the mesorectum from the ventrolateral (35.7%), lateral (42.9%), or dorsolateral (21.4%) aspect. The middle rectal artery was accompanied by podoplanin-immunoreactive lymphatic vessels and gave off additional branches (81.8%) to the urogenital pelvic organs. Three-dimensional reconstruction revealed the complex course of the middle rectal artery from the pelvic sidewall through the pelvic nerve plexus and parietal pelvic fascia into the mesorectum. LIMITATIONS Findings retrieved from body donors may be prone to age- and fixation-related processes. CONCLUSIONS The investigation disclosed the rather high prevalence of the middle rectal artery, its 3-dimensional topographic anatomy, and its proximity to the autonomic pelvic nerves. These features play a role in the surgical management of this blood vessel. The data provide the anatomical rationale for the lateral lymphatic spread of rectal cancer and an anatomical basis for nerve-preserving lateral lymph node dissection.
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Zhou J, Yuan X. Lateral Lymph Node Dissection Was Unnecessary for Low and Middle Rectal Cancer: a Systematic Review and Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Tang J, Zhou S, Zhao W, Lou Z, Liang J, Feng B, Yang Y, Wang X, Liu Q. Short- and long-term outcomes of laparoscopic versus open selective lateral pelvic lymph node dissection for locally advanced middle-low rectal cancer: Results of a multicentre lateral node study in China. Colorectal Dis 2022; 24:1325-1334. [PMID: 35713974 DOI: 10.1111/codi.16223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 02/08/2023]
Abstract
AIM Lateral pelvic lymph node dissection (LPND) is a technically challenging procedure, and the safety and feasibility of laparoscopic LPND remains undetermined. Here, we compared the short- and long-term survival outcomes of laparoscopic LPND with those of open LPND. METHODS From January 2012 to December 2019, locally advanced middle-low rectal cancer patients with clinical evidence of lateral pelvic lymph node metastasis (LPNM) who underwent total mesorectal excision with LPND at three institutions were included. Propensity score matching was used to minimize selection bias. The short-term and oncological outcomes of open and laparoscopic LPND were compared. RESULTS Overall, 384 patients were enrolled into the study including 277 and 107 patients who underwent laparoscopic and open LPND, respectively. After matching, patients were stratified into laparoscopic (n = 100) and open (n = 100) LPND groups. Patients in the laparoscopic LPND group had a shorter operation time (255 vs. 300 min, p = 0.001), less intraoperative blood loss (50 vs. 300 ml, p < 0.001), lower incidence of postoperative complications (32.0% vs. 15.0%, p = 0.005), shorter postoperative hospital stay (8 vs. 14 days, p < 0.001), and excision of more lateral pelvic lymph nodes (9 vs. 7, p = 0.025) than those in the open LPND group. The 3-year overall survival (p = 0.581) and 3-year disease-free survival (p = 0.745) rates were similar between the groups, and LPNM was an independent predictor of survival. CONCLUSION Laparoscopic LPND is technically safe and feasible with favourable short-term results and similar oncological outcomes as open surgery in selected patients.
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Affiliation(s)
- Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China
| | - Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, Nava Military Medical University, Shanghai, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Feng
- Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Yingchi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xin Wang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hamabe A, Ishii M, Kamoda R, Sasuga S, Okuya K, Okita K, Akizuki E, Miura R, Korai T, Takemasa I. Artificial intelligence-based technology to make a three-dimensional pelvic model for preoperative simulation of rectal cancer surgery using MRI. Ann Gastroenterol Surg 2022; 6:788-794. [PMID: 36338585 PMCID: PMC9628238 DOI: 10.1002/ags3.12574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023] Open
Abstract
Aim A new technique that allows visualization of whole pelvic organs with high accuracy and usability is needed for preoperative simulation in advanced rectal cancer surgery. In this study, we developed an automated algorithm to create a three-dimensional (3D) model from pelvic MRI using artificial intelligence (AI) technology. Methods This study included a total of 143 patients who underwent 3D MRI in a preoperative examination for rectal cancer. The training dataset included 133 patients, in which ground truth labels were created for pelvic vessels, nerves, and bone. A 3D variant of U-net was used for the network architecture. Ten patients who underwent lateral lymph node dissection were used as a validation dataset. The correctness of the vascular labelling was assessed for pelvic vessels and the Dice similarity coefficients calculated for pelvic bone. Results An automatic segmentation algorithm that extracts the artery, vein, nerve, and pelvic bone was developed, automatically producing a 3D image of the entire pelvis. The total time needed for segmentation was 133 seconds. The success rate of the AI-based segmentation was 100% for the common and external iliac vessels, but the rates for the vesical vein (75%), superior gluteal vein (60%), or accessory obturator vein (63%) were suboptimal. Regarding pelvic bone, the average Dice similarity coefficient between manual and automatic segmentation was 0.97 (standard deviation 0.0043). Conclusion Though there is room to improve the segmentation accuracy, the algorithm developed in this study can be utilized for surgical simulation in the treatment of advanced rectal cancer.
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Affiliation(s)
- Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | | | | | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Ryo Miura
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Takahiro Korai
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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29
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Sato H, Maeda K, Kinugasa Y, Kagawa H, Tsukamoto S, Takahashi K, Nozawa H, Takii Y, Konishi T, Akagi Y, Suto T, Yamaguchi S, Ozawa H, Komori K, Ohue M, Hiro J, Shinji S, Minami K, Shimizu T, Sakamoto K, Uehara K, Takahashi H, Sugihara K. Management of inguinal lymph node metastases from rectal and anal canal adenocarcinoma. Colorectal Dis 2022; 24:1150-1163. [PMID: 35505622 DOI: 10.1111/codi.16169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/08/2023]
Abstract
AIM The surgical treatment of inguinal lymph node (ILN) metastases secondary to anorectal adenocarcinoma remains controversial. This study aimed to clarify the surgical treatment and management of ILN metastasis according to its classification. METHODS This retrospective, multi-centre, observational study included patients with synchronous or metachronous ILN metastases who were diagnosed with rectal or anal canal adenocarcinoma between January 1997 and December 2011. Treatment outcomes were analysed according to recurrence and prognosis. RESULTS Among 1181 consecutively enrolled patients who received treatment for rectal or anal canal adenocarcinoma at 20 referral hospitals, 76 (6.4%) and 65 (5.5%) had synchronous and metachronous ILN metastases, respectively. Among 141 patients with ILN metastasis, differentiated carcinoma, solitary ILN metastasis and ILN dissection were identified as independent predictive factors associated with a favourable prognosis. No significant difference was found in the frequency of recurrence after ILN dissection between patients with synchronous (80.6%) or metachronous (81.0%) ILN metastases. Patients who underwent R0 resection of the primary tumour and ILN dissection had a 5-year survival rate of 41.3% after ILN dissection (34.1% and 53.1% for patients with synchronous and metachronous ILN metastases, respectively, P = 0.55). CONCLUSION The ILN can be appropriately classified as a regional lymph node in rectal and anal canal adenocarcinoma. Moreover, aggressive ILN dissection might be effective in improving the prognosis of low rectal and anal canal adenocarcinoma with ILN metastases; thus, prophylactic ILN dissection is unnecessary.
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Affiliation(s)
- Harunobu Sato
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Yusuke Kinugasa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyasu Kagawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Shunsuke Tsukamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keiichi Takahashi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
| | - Hiroaki Nozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasumasa Takii
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tsuyoshi Konishi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yoshito Akagi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takeshi Suto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shigeki Yamaguchi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,Division of Colorectal Surgery, Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Heita Ozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Koji Komori
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Ohue
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichiro Hiro
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Seiichi Shinji
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuhito Minami
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomoharu Shimizu
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Medical Safety Section, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiro Sakamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kay Uehara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Takahashi
- Department of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Sugihara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Zhang C, Cui M, Xing J, Yang H, Yao Z, Zhang N, Tan F, Liu M, Xu K, Su X. Effect of lateral lymph nodes without malignant characteristics on the prognosis of patients with rectal cancer. Future Oncol 2022; 18:3509-3518. [PMID: 36317561 DOI: 10.2217/fon-2022-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Lateral lymph node (LLN) metastasis is a poor prognostic factor for rectal cancer patients. However, the effect of LLNs without malignant characteristics on the prognosis of rectal cancer patients has been uncertain. Methods: Consecutive patients who underwent laparoscopic-assisted low anterior resection were included. Patients with MRI-detected LLNs, but without malignant characteristics, were compared with patients with no MRI-detected LLNs. Results: The local recurrence rate was higher in the LLN-present group than in the LLN-absent group (9.8% vs 2.5%; p = 0.056). The overall survival of patients with no MRI-detected LLNs was significantly better than that of patients with MRI-detected LLNs (p = 0.021). Conclusion: The presence of LLNs, even without malignant features, may lead to worse local control and overall survival.
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Affiliation(s)
- Chenghai Zhang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Ming Cui
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Hong Yang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Fei Tan
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Kai Xu
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
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Zhou S, Tang J, Liang J, Lou Z, Fu W, Feng B, Yang Y, Xiao Y, Liu Q. Effective dissecting range and prognostic significance of lateral pelvic lymph node dissection for middle-low rectal cancer patients with lateral pelvic lymph node metastasis: Results of a large multicenter lateral node collaborative group in China. Front Oncol 2022; 12:916285. [PMID: 36033473 PMCID: PMC9413157 DOI: 10.3389/fonc.2022.916285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Lateral pelvic lymph node (LPN) metastasis causes increased lateral local recurrence and poor prognosis. We aimed to investigate the prognostic significance and effective range of dissection for the LPN dissection (LPND) in rectal cancer patients with LPN metastasis. Materials and methods Through this large, multicenter retrospective cohort study, we evaluated the therapeutic effect of LPND. From January 2012 to December 2019, 387 rectal cancer patients with clinical evidence of LPN metastasis who underwent total mesorectal excision with LPND were included in the study. According to pathological findings, they were divided into negative (n = 296) and positive (n = 91) LPN groups. Primary endpoints were 3-year overall survival (OS), recurrence-free survival (RFS), and local recurrence-free survival (LRFS). Results The OS, RFS, and LRFS in the positive group were significantly worse than those in the negative group; However, LPN metastases were not independent prognostic risk factors for LRFS (hazard ratio [HR]: 2.42; 95% confidence interval [CI], 0.77–7.64; P=0.132). Among patients with pathological LPN metastases, LPN metastases to the common and external iliac arteries were independent prognostic risk factors both for OS (HR: 4.74; 95% CI, 1.74–12.90; P=0.002) and RFS (HR: 2.70; 95% CI, 1.16–6.29; P=0.021). No significant difference was observed in the 3-year OS (72.3% vs. 70.2%, P=0.775) and RFS rates (60.9% vs. 52.6%, P=0.408) between patients with metastases to the obturator or internal iliac arteries and patients at N2b stage. Conclusions LPND may be effective in controlling local recurrence in patients with LPN metastasis but not systemic metastases. Patients with LPN metastasis limited to the internal iliac and obturator regions achieve a long-term survival benefit from LPND, and their prognoses may be comparable to those at the N2b stage. Further metastasis to the external iliac or common iliac region should be considered systemic disease, and LPND should be avoided. Clinical Trial Registration ClinicalTrials.gov, identifier NCT04850027.
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Affiliation(s)
- Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Lou
- Department of Colorectal Surgery, The first affiliated hospital, Navy Medical University, Shanghai, China
| | - Wei Fu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yi Xiao, ; Qian Liu,
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yi Xiao, ; Qian Liu,
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Near-Infrared Imaging Using Indocyanine Green for Laparoscopic Lateral Pelvic Lymph Node Dissection for Clinical Stage II/III Middle-Lower Rectal Cancer: A Propensity Score-Matched Cohort Study. Dis Colon Rectum 2022; 65:885-893. [PMID: 34840301 DOI: 10.1097/dcr.0000000000002156] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The examination of the efficacy of near-infrared imaging using indocyanine green in laparoscopic lateral pelvic lymph node dissection remains insufficient. OBJECTIVE The aim of this study was to examine whether near-infrared imaging contributed to an increase in the total number of harvested lateral pelvic lymph nodes in laparoscopic lateral pelvic lymph node dissection. DESIGN This was a retrospective, multi-institutional study with propensity score matching. SETTINGS We conducted this study within the framework of the Yokohama Clinical Oncology Group in Japan. PATIENTS The study population included consecutive patients with middle-low rectal cancer (clinical stage II to III) who underwent laparoscopic lateral pelvic lymph node dissection between January 2013 and February 2018. MAIN OUTCOME MEASURES The total number of harvested lateral pelvic lymph nodes was compared in laparoscopic lateral pelvic lymph node dissection with and without near-infrared imaging. RESULTS A total of 172 eligible patients were included; 84 of these patients underwent laparoscopic surgery with near-infrared imaging. After propensity score matching, 58 patients were matched in each of the near-infrared and the non-near-infrared groups. The operation time in the near-infrared group was significantly longer than that in the non-near-infrared group (426 vs 369 min), and the amount of intraoperative blood loss in the near-infrared group was significantly smaller than that in the non-near-infrared group (13 vs 110 mL). The total number of harvested lateral pelvic lymph nodes in the near-infrared group was significantly higher than that in the non-near-infrared group (14 vs 9). There were no significant differences in the postoperative complication rates of the 2 groups. LIMITATIONS The limitations of the present study include its retrospective design. CONCLUSIONS This study revealed that laparoscopic lateral pelvic lymph node dissection combined with near-infrared imaging could increase the total number of harvested lateral pelvic lymph nodes without impairing functional preservation. See Video Abstract at http://links.lww.com/DCR/B800.This study was registered with the Japanese Clinical Trials Registry as UMIN000041372 (http://www.umin.ac.jp/ctr/index.htm).IMÁGENES CASI-INFRARROJAS UTILIZANDO VERDE DE INDOCIANINA EN LA DISECCIÓN LAPAROSCÓPICA DE GANGLIOS LINFÁTICOS PÉLVICOS LATERALES EN CASOS DE CÁNCER DE RECTO MEDIO-INFERIOR DE ESTADIO CLÍNICO II / III: ESTUDIO DE COHORTES CON PUNTUACIÓN DE PROPENSIÓNANTECEDENTES:El examen de la eficacia de las imágenes casi-infrarrojas utilizando le verde de indocianina en la disección laparoscópica de los ganglios linfáticos pélvicos laterales sigue siendo insuficiente.OBJETIVO:El objetivo de este estudio fue examinar si las imágenes casi-infrarrojas contribuyeron a un aumento en el número total de ganglios linfáticos pélvicos laterales recolectados durante su disección laparoscópica.DISEÑO:Estudio retrospectivo, multi-institucional con emparejamiento por puntuación de propensión.AJUSTES:Estudio realizado dentro el marco establecido por el Grupo de Oncología Clínica de Yokohama, Japón.PACIENTES:La población estudiada incluyó pacientes consecutivos con cáncer de recto medio-bajo (estadio clínico II a III) que se sometieron a una disección laparoscópica de los ganglios linfáticos pélvicos laterales entre enero de 2013 y febrero de 2018.PRINCIPALES RESULTADOS MEDIDAS:El número total de ganglios linfáticos pélvicos laterales extraídos se comparó en la disección laparoscópica de ganglios linfáticos pélvicos laterales con y sin imágenes casi-infrarrojas.RESULTADOS:Se incluyeron un total de 172 pacientes elegibles; 84 de estos pacientes se sometieron a cirugía laparoscópica con imágenes casi-infrarrojas. Después del emparejamiento por puntuación de propensión, 58 pacientes fueron emparejados en cada uno de los grupos de luz casi-infrarroja y los sin luz. El tiempo de operación en el grupo de luz casi-infrarroja fue significativamente más largo que en el grupo sin luz (426 frente a 369 min), y la cantidad de pérdida de sangre intraoperatoria en el grupo de luz casi-infrarroja fue significativamente menor que en el grupo sin luz (13 frente a 110 ml). El número total de ganglios linfáticos pélvicos laterales recolectados en el grupo de luz casi-infrarroja fue significativamente mayor que en el grupo sin luz (14 frente a 9). No hubo diferencias significativas en las tasas de complicaciones posoperatorias de los dos grupos.LIMITACIONES:Las limitaciones del presente estudio incluyen su diseño retrospectivo.CONCLUSIONES:Este estudio reveló que la disección laparoscópica de los ganglios linfáticos pélvicos laterales combinada con imágenes casi-infrarrojas podría aumentar el número total de ganglios linfáticos pélvicos laterales recolectados sin afectar la preservación funcional. Consulte Video Resumen en http://links.lww.com/DCR/B800. (Traducción-Dr. Xavier Delgadillo)Este estudio se registró en el Registro de Ensayos Clínicos de Japón como UMIN000041372 (http://www.umin.ac.jp/ctr/index.htm).
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Ishizaki T, Mazaki J, Enomoto M, Udo R, Tago T, Kasahara K, Kuwabara H, Katsumata K, Nagakawa Y. A new technique for robotic lateral pelvic lymph node dissection for advanced low rectal cancer with emphasis on en bloc resection and inferior vesical vessel preservation. Surg Endosc 2022; 36:7789-7793. [DOI: 10.1007/s00464-022-09275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/09/2022] [Indexed: 11/24/2022]
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Sakamoto Y, Morohashi H, Miura T, Tsutsumi S, Takahashi S, Hirama K, Wakiya T, Hakamada K. A Prospective Multicenter Phase II Study on the Feasibility and Efficacy of S-1 and Oxaliplatin Neoadjuvant Chemotherapy for Locally Advanced Rectal Cancer. Dis Colon Rectum 2022; 65:663-671. [PMID: 33833145 DOI: 10.1097/dcr.0000000000001927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy and total mesorectal excision compose the standard of care for rectal cancer in multiple guidelines. However, neoadjuvant chemoradiotherapy has not exhibited clear survival benefits but rather has led to an increase in adverse events. Conversely, neoadjuvant chemotherapy is expected to prevent adverse events caused by radiation, yet this treatment is still controversial. OBJECTIVE The purpose of this study was to evaluate the feasibility and efficacy of S-1 and oxaliplatin neoadjuvant chemotherapy together with total mesorectal excision for resectable locally advanced rectal cancer. DESIGN The study was a prospective, single-arm phase II trial. SETTINGS The study was conducted at multiple institutions. PATIENTS Fifty-eight patients with resectable locally advanced rectal cancer were enrolled. INTERVENTION Three cycles of S-1 and oxaliplatin were administered before surgery. S-1 was administered orally at 80 mg/m2 per day for 14 consecutive days, followed by a 7-day resting period. Oxaliplatin was given intravenously on the first day at a dose of 130 mg/m2 per day. The duration of 1 cycle was considered to be 21 days. Total mesorectal excision with bilateral lymph node dissection was carried out after neoadjuvant chemotherapy. MAIN OUTCOME MEASURES The study was designed to detect the feasibility and efficacy of S-1 and oxaliplatin as neoadjuvant chemotherapy. RESULTS The completion rate of 3 courses of S-1 and oxaliplatin as neoadjuvant chemotherapy was 94.8% (55/58). The reasons for discontinuation were thrombocytopenia (3.4%) and liver injury (1.7%). The most common severe (grade ≥3) adverse effect of neoadjuvant chemotherapy was thrombocytopenia (3.4%). There were no severe adverse clinical symptoms. Consequently, R0 resection was achieved in 51 (98.1%) of 52 patients. Pathologic complete response occurred in 10 patients (19.2%). LIMITATIONS This was a single-arm, nonrandomized phase II study. CONCLUSIONS The combination of S-1 and oxaliplatin neoadjuvant chemotherapy and total mesorectal excision is a feasible and promising treatment option for resectable locally advanced rectal cancer. See Video Abstract at http://links.lww.com/DCR/B555. UN ESTUDIO PROSPECTIVO MULTICNTRICO FASE II SOBRE LA FACTIBILIDAD Y EFICACIA DE LA QUIMIOTERAPIA NEOADYUVANTE SCON OXALIPLATINO PARA EL CNCER DE RECTO LOCALMENTE AVANZADO ANTECEDENTES:La quimiorradioterapia neoadyuvante y la escisión mesorrectal total constituyen el estándar de atención para el cáncer de recto en varias guías. Sin embargo, la quimiorradioterapia neoadyuvante no ha mostrado beneficios claros en la sobrevida, pero si ha creado un aumento de eventos adversos. Por otro lado, se espera que la quimioterapia neoadyuvante prevenga los eventos adversos asociados a la radiación, aunque este tratamiento sigue siendo controvertido.OBJETIVO:Evaluar la factibilidad y eficacia de la quimioterapia neoadyuvante S-1 con oxaliplatino en conjunto con la escisión mesorrectal total para el cáncer de recto localmente avanzado resecable.DISEÑO:El estudio fue un ensayo prospectivo fase II de brazo único.AMBITO:Estudio realizado en múltiples instituciones.PACIENTES:Se incluyeron 58 pacientes con cáncer de recto localmente avanzado resecable.INTERVENCIÓN:Se administraron tres ciclos de S-1 con oxaliplatino antes de la cirugía. Se administró S-1 por vía oral a 80 mg / m2 / día durante 14 días consecutivos, seguido de un período de descanso de 7 días. El oxaliplatino se administró por vía intravenosa el primer día a una dosis de 130 mg / m2 / día. Se consideró la duración de un ciclo de 21 días. Posterior a la quimioterapia neoadyuvante se realizó la excisión total mesorrectal con disección ganglionar bilateral.PRINCIPALES VARIABLES EVALUDADAS:El estudio fue diseñado para conocer la factibilidad y eficacia de S-1 con oxaliplatino como quimioterapia neoadyuvante.RESULTADOS:La tasa de conclusión con tres ciclos de S-1 con oxaliplatino como quimioterapia neoadyuvante fue del 94,8% (55/58). Los motivos de interrupción fueron trombocitopenia (3,4%) y daño hepático (1,7%). El efecto adverso grave más común (grado ≥ 3) de la quimioterapia neoadyuvante fue la trombocitopenia (3,4%). No hubo síntomas clínicos adversos graves. Como resultado, la resección R0 se logró en 51 de 52 pacientes (98,1%). Una respuesta patológica completa se obtuvo en 10 pacientes (19,2%).LIMITACIONES:Fue un estudio de fase II no aleatorizado de un solo brazo.CONCLUSIONES:La combinación de S-1 con oxaliplatino como quimioterapia neoadyuvante y escisión mesorrectal total es factible y es una opción de tratamiento prometedora para el cáncer de recto localmente avanzado resecable. Consulte Video Resumen en http://links.lww.com/DCR/B555. (Traducción-Dr Juan Antonio Villanueva-Herrero).
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Affiliation(s)
- Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | | | | | | | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
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Hojo D, Murono K, Nozawa H, Kawai K, Hata K, Tanaka T, Oba K, Ishihara S. Improvement in Surgical Outcomes Using 3-Dimensional Printed Models for Lateral Pelvic Lymph Node Dissection in Rectal Cancer. Dis Colon Rectum 2022; 65:566-573. [PMID: 34775410 DOI: 10.1097/dcr.0000000000002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lateral pelvic lymph node dissection for rectal cancer is challenging due to the complexity of the pelvic wall anatomy, and incomplete lateral pelvic lymph node dissection may result in local recurrence in the lateral pelvis. Although 3-dimensional printed organ models are useful for understanding spatial anatomy, it is currently unclear whether they improve surgical outcomes. OBJECTIVE We aimed to assess whether the surgical effectiveness of lateral pelvic lymph node dissection is increased by the use of individualized 3-dimensional printed pelvic models. DESIGN This was a retrospective study using a propensity matching analysis. SETTINGS This study was conducted at a university hospital in Japan. PATIENTS In total, 115 patients comprising 184 pelvic sides (right, 85 sides; left, 99 sides) who underwent lateral pelvic lymph node dissection for colorectal adenocarcinoma between January 2012 and December 2019 were enrolled. INTERVENTIONS We compared surgical outcomes using 3-dimensional printed pelvic models with control outcomes. MAIN OUTCOME MEASURES The primary outcome was the number of harvested lateral pelvic lymph nodes on 1 pelvic side after the propensity matching analysis. RESULTS After matching, 35 pelvic sides each were allocated to the 3-dimensional model and control groups, and no significant differences were observed in patient characteristics between the 2 groups. The number of harvested lateral pelvic lymph nodes was significantly higher in the 3-dimensional model group (median, 9; range, 3-16) than in the control group (median, 6; range, 0-22; p = 0.047). LIMITATIONS This was a retrospective study using propensity score matching. However, historical backgrounds were not matched, and the majority of lateral pelvic lymph node dissection procedures in the 3-dimensional model group were recently performed. This limitation may have influenced surgical outcomes. CONCLUSION The present study demonstrated that, by referring to individualized 3-dimensional printed pelvic models, colorectal surgeons harvested a larger number of lateral pelvic lymph nodes during lateral pelvic lymph node dissection. This result suggests that 3-dimensional printed models help surgeons to complete more detailed procedures. See Video Abstract at http://links.lww.com/DCR/B776. MEJORA DE LOS RESULTADOS QUIRRGICOS MEDIANTE EL USO DE MODELOS IMPRESOS EN D PARA LA DISECCIN LATERAL DE LOS GANGLIOS LINFTICOS PLVICOS EN EL CNCER DE RECTO ANTECEDENTES:La disección lateral de los ganglios linfáticos de la pelvis en el cáncer de recto es un desafío debido a la complejidad de la anatomía de la pared pélvica; la disección incompleta de las mismas puede resultar en una recidiva local en dicha zona. Aunque la impresión tridimensional de modelos de órganos es útil para comprender la estructura anatómica espacial, actualmente no está claro si mejoran los resultados quirúrgicos.OBJETIVO:Nuestro objetivo fue evaluar si la efectividad quirúrgica de la disección de los ganglios linfáticos laterales de la pelvis aumenta mediante el uso individualizado de modelos pélvicos impresos en 3D.DISEÑO:Este fue un estudio retrospectivo que utilizó un análisis de coincidencia de propensión.AJUSTE:Este estudio se realizó en un hospital universitario de Japón.PACIENTES:En total, se enrolaron 115 pacientes que comprendían 184 lados pélvicos (85 de lado derecho; 99 de lado izquierdo) que fueron sometidas a disección lateral de ganglios linfáticos de la pelvis por adenocarcinoma colorrectal entre enero de 2012 y diciembre de 2019.INTERVENCIONES:Comparamos los resultados quirúrgicos mediante modelos pélvicos tridimensionales impresos con los resultados de control.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue el número de ganglios linfáticos laterales pélvicos extraídos en un lado pélvico después del análisis de coincidencia de propensión.RESULTADOS:Después del emparejamiento, se asignaron 35 lados pélvicos cada uno, tanto al modelo tridimensional como al grupo de control; no se observaron diferencias significativas con respecto a las características de los pacientes entre los dos grupos. El número de ganglios linfáticos pélvicos laterales extraídos fue significativamente mayor en el grupo del modelo tridimensional (mediana, 9; rango 3-16) que en el grupo de control (mediana, 6; rango, 0-22) (p = 0.047).LIMITACIONES:Este fue un estudio retrospectivo que utilizó el emparejamiento por puntuación de propensión. Sin embargo, antecedentes históricos no fueron encontrados y la mayoría de los procedimientos de disección de los ganglios linfáticos laterales pélvicos en el grupo del modelo tridimensional se realizaron recientemente. Esta limitación pudo haber influido en los resultados quirúrgicos.CONCLUSIONES:El presente estudio demostró que al referirse a modelos pélvicos individualizados impresos en 3D, los cirujanos colorrectales recolectaron un mayor número de ganglios linfáticos laterales de la pelvis durante la disección lateral. Este resultado sugiere que los modelos tridimensionales impresos ayudan a los cirujanos a completar procedimientos más detallados. Consulte Video Resumen en http://links.lww.com/DCR/B776.
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Affiliation(s)
- Daisuke Hojo
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Chen Z, Sasaki K, Murono K, Kawai K, Nozawa H, Kobayashi H, Ishihara S, Sugihara K. Oncologic Status of Obturator Lymph Node Metastases in Locally Advanced Low Rectal Cancer: A Japanese Multi-Institutional Study of 3487 Patients. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11372-z. [PMID: 35243595 DOI: 10.1245/s10434-022-11372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer tumor-node-metastasis staging system for rectal cancer defines lateral pelvic lymph nodes (LPLNs) only in the internal iliac region as regional. However, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) staging system, also considers obturator lymph nodes (LNs) as regional. This retrospective cohort study evaluated the oncologic status of obturator LNs in low rectal cancer. METHODS The study identified 3487 patients with pT3-T4 low rectal cancer who had undergone curative resections without preoperative radiotherapy or chemotherapy between 2003 and 2011 in the JSCCR database and divided them into six groups. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by groups. RESULTS Histologic LPLN metastases were identified in 8% (279/3487) of all the patients and in 18.2% (279/1530) of the patients who underwent lateral pelvic node dissection. The 5-year OS and RFS rates of the obturator-LPLN group (P = 0.095) were worse than those of the internal-LPLN group (P = 0.075), but the difference was not significant. The OS of the obturator-LPLN group was similar to that of the resectable liver metastasis group (P = 0.731), and the RFS of the obturator-LPLN group was significantly better than that of the other-LPLN group (P = 0.016). CONCLUSION The prognosis for obturator LN metastases in low rectal cancer was not significantly worse than for internal iliac LN metastases, defined as regional by the current American Joint Committee on Cancer staging system, and the oncologic status of obturator LNs warrants more studies.
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Affiliation(s)
- Zhifen Chen
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Koji Murono
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kazushige Kawai
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hioaki Nozawa
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University, Mizonokuchi Hospital, Kawasaki-city, Kanagawa, Japan
| | - Soichiro Ishihara
- Department of Colorectal Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
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Shinto E, Ike H, Ito M, Takahashi K, Ohue M, Kanemitsu Y, Suto T, Kinugasa T, Watanabe J, Hida JI, Itabashi M, Ozawa H, Nozawa H, Kobayashi H, Hashiguchi Y, Hase K, Sugihara K. OUP accepted manuscript. BJS Open 2022; 6:6544103. [PMID: 35257141 PMCID: PMC8902341 DOI: 10.1093/bjsopen/zrac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Patients with lateral node metastasis in low rectal cancers have a poor prognosis. However, variability in patient survival in terms of lateral metastatic status has not been thoroughly investigated. This study was conducted to assess the prognostic value of lateral node involvement and to review nodal classification. Methods Patients with stage III low rectal cancers who underwent lateral node dissection were retrospectively reviewed. Two cohorts were set: the first one (1995–2006) was selected using a Japanese multi-institutional database and was used for development of a new nodal system, and the second (2007–2013) was collected from referral institutions for validation of findings. Variables correlated with poor prognosis were investigated. Next, a modified classification of lateral-positive nodal cancers was created. Finally, this new classification was compared with TNM and Japanese classification-based systems according to the Akaike information criterion (AIC) and concordance index (c-index). Results Overall, 742 and 508 patients were selected for cohorts 1 and 2, respectively. Based on the analyses on cohort 1, patients with two or more lateral metastatic nodes partially spreading into regions outside of internal iliac area exhibited poor prognosis; accordingly, a modified N classification was created, where TNM-N1 and N2a cancers with this feature were upgraded, respectively, to N2a and N2b. The modified N classification yielded the most favourable indices (AIC = 2661.08; c-index = 0.6477) compared with the TNM (AIC = 2662.36; c-index = 0.6457) and Japanese classification-based systems (AIC = 2684.06; c-index = 0.6302). All findings were confirmed by analysing cohort 2. Conclusion A modified nodal system is proposed to account for the significance of lateral node metastasis.
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Affiliation(s)
- Eiji Shinto
- Correspondence to: Eiji Shinto, Department of Surgery National Defense Medical College 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan (e-mail: )
| | - Hideyuki Ike
- Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, Yokohama, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital, Yamagata, Japan
| | | | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jin-ichi Hida
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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Kim MC, Oh JH. Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review. Ann Coloproctol 2021; 37:382-394. [PMID: 34961302 PMCID: PMC8717070 DOI: 10.3393/ac.2021.00913.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI). Methods We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method. Results The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094). Conclusion This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.
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Affiliation(s)
- Min Chul Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Zhou S, Jiang Y, Pei W, Liang J, Zhou Z. Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis. BMC Surg 2021; 21:441. [PMID: 34961494 PMCID: PMC8714447 DOI: 10.1186/s12893-021-01443-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
AIM It is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM). METHODS Patients with clinically suspected LPNM who underwent nCRT followed by TME + LPND were systematically reviewed and divided into the positive LPN group (n = 15) and the negative LPN group (n = 58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed. RESULTS Of the 73 patients undergoing TME + LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN short diameter ≥ 7 mm (OR 49.65; 95% CI 3.98-619.1; P = 0.002) and lymphatic invasion (OR 9.23; 95% CI 1.28-66.35; P = 0.027) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P = 0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR 3.82; 95% CI 1.19-12.25; P = 0.024) but also for disease-free survival (DFS) (HR 2.33; 95% CI 1.02-5.14; P = 0.044). Moreover, N1-N2 stage was another independent risk factor for OS (HR 7.41; 95% CI 1.63-33.75; P = 0.010). CONCLUSIONS Post-nCRT LPN short diameter ≥ 7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis after TME + LPND. Strict patient selection and intensive perioperative chemotherapy are crucial factors to ensure the efficacy of LPND.
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Affiliation(s)
- Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
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Mahendran B, Balasubramanya S, Sebastiani S, Smolarek S. Extended Lymphadenectomy in Locally Advanced Rectal Cancers: A Systematic Review. Ann Coloproctol 2021:ac.2021.00703.0100. [PMID: 34788526 PMCID: PMC8898625 DOI: 10.3393/ac.2021.00703.0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies. Methods All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3- and 5-year disease-free survival, length of operation, and number of complications. Results Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09–0.5; P=0.006). There were no differences noted in secondary outcomes except for length of the operations. Conclusion There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.
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Affiliation(s)
- Balaji Mahendran
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Supriya Balasubramanya
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Simone Sebastiani
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Sebastian Smolarek
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Sluckin TC, Hazen SJA, Kusters M. From "East vs West" towards international multidisciplinary collaboration: An appraisal of lateral lymph nodes in rectal cancer. Ann Gastroenterol Surg 2021; 5:731-737. [PMID: 34755004 PMCID: PMC8560594 DOI: 10.1002/ags3.12490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022] Open
Abstract
Western and Eastern practices have traditionally differed in their approach to treating lateral lymph nodes in rectal cancer. While Western clinicians have primarily favored neoadjuvant (chemo)radiotherapy to sterilize lateral compartments, Eastern physicians have often opted for the surgical removed of lymphatic tissue with a lateral lymph node dissection without neoadjuvant treatment. The literature suggests similar oncological outcomes for these two separate techniques, while tangible differences exist. The combination of these paradigms may be beneficial in reducing overall morbidity while sustaining low recurrence rates. This article considers traditional Eastern and Western perspectives, discusses nodal features important for predicting malignancy and attempts to stimulate international, multidisciplinary consensus and collaboration.
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Affiliation(s)
- Tania C. Sluckin
- Department of SurgeryAmsterdam University Medical CentersVrije Universiteit AmsterdamCancer Center AmsterdamAmsterdamThe Netherlands
| | - Sanne‐Marije J. A. Hazen
- Department of SurgeryAmsterdam University Medical CentersVrije Universiteit AmsterdamCancer Center AmsterdamAmsterdamThe Netherlands
| | - Miranda Kusters
- Department of SurgeryAmsterdam University Medical CentersVrije Universiteit AmsterdamCancer Center AmsterdamAmsterdamThe Netherlands
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Ogawa S, Itabashi M, Inoue Y, Ohki T, Bamba Y, Koshino K, Nakagawa R, Tani K, Aihara H, Kondo H, Yamaguchi S, Yamamoto M. Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management. World J Gastrointest Oncol 2021; 13:1412-1424. [PMID: 34721774 PMCID: PMC8529924 DOI: 10.4251/wjgo.v13.i10.1412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/21/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer are described in this review. Magnetic resonance imaging (MRI) is recommended for the diagnosis of LPLN metastasis. A LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications; therefore, LPLD may not be appropriate for cases that are less likely to have LPLN metastasis. Radiation therapy (RT) and chemoradiation therapy (CRT) have limited effects in cases with suspected LPLN metastasis, but a combination of preoperative CRT and LPLD may improve the treatment outcome. Thus, RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.
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Affiliation(s)
- Shimpei Ogawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yuji Inoue
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yoshiko Bamba
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kurodo Koshino
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Ryosuke Nakagawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kimitaka Tani
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hisako Aihara
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hiroka Kondo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Shigeki Yamaguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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Metachronous common iliac lymph node metastasis after rectosigmoid colon cancer resection: A case report. Int J Surg Case Rep 2021; 85:106203. [PMID: 34280878 PMCID: PMC8318923 DOI: 10.1016/j.ijscr.2021.106203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction and importance Metastases to common iliac lymph nodes from cancer of the rectosigmoid are extremely rare. We report a patient with a right common iliac lymph node metastasis after rectosigmoid cancer resection. Case presentation The patient is a 57-year-old woman diagnosed with rectosigmoid cancer (Stage IIIc) who underwent laparoscopic resection followed by 8 courses of adjuvant chemotherapy with capecitabine. Sixteen months after resection, an intra-abdominal mass and a left lung nodule were found on computed tomography scans, which were suspected to be recurrences. Exploratory laparoscopy showed that the abdominal lesion was an enlarged common iliac lymph node, which was completely excised. No other intraabdominal recurrences were found. Subsequently, a left upper lobe lung metastasis was resected thoracoscopically. However, multiple lung metastases developed four months after the lung resection, and systemic therapy was begun. Clinical discussion A lower incidence of lateral lymph node metastases from cancer in the rectosigmoid has been reported. Direct lymphatic pathways from the sigmoid colon or rectosigmoid to lateral lymph nodes have been suspected, which may be associated with the poor prognosis in this patient. Conclusion A metachronous metastasis to a common iliac lymph node from primary rectosigmoid cancer is reported. Common iliac lymph node metastases from rectosigmoid cancer might have more malignant potential, and should be treated in the same manner as peri-aortic lymph node metastases.
Metastases to common iliac lymph nodes from rectosigmoid cancer are extremely rare. Direct spread from the rectosigmoid to a common iliac lymph node is suspected. The lymph node metastasis was excised laparoscopically. A direct lymphatic pathway may be associated with a poor prognosis.
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Hida K, Nishizaki D, Sumii A, Okamura R, Sakai Y, Konishi T, Akagi T, Yamaguchi T, Akiyoshi T, Fukuda M, Yamamoto S, Arizono S, Uemura M, Hasegawa H, Kawada K, Morita S, Watanabe M. Prognostic Impact of Lateral Pelvic Node Dissection on the Survival of Patients in Low Rectal Cancer Subgroups Based on Lymph Node Size. Ann Surg Oncol 2021; 28:6179-6188. [PMID: 34255243 DOI: 10.1245/s10434-021-10312-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
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. Trial registration UMIN-ID: UMIN000013919.
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Affiliation(s)
- Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
| | | | - Atsuhiko Sumii
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Ryosuke Okamura
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Meiki Fukuda
- Department of Gastroenterological Surgery, Kitano Hospital, Osaka, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Shigeki Arizono
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Kenji Kawada
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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45
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Dry Lab Training Model of Laparoscopic Lateral Pelvic Lymph Node Dissection for Rectal Cancer. Dis Colon Rectum 2021; 64:e387-e388. [PMID: 33872282 DOI: 10.1097/dcr.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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46
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Kroon HM, Malakorn S, Dudi-Venkata NN, Bedrikovetski S, Liu J, Kenyon-Smith T, Bednarski BK, Ogura A, van de Velde CJH, Rutten HJT, Beets GL, Thomas ML, Kusters M, Chang GJ, Sammour T. Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study. Eur J Surg Oncol 2021; 47:2441-2449. [PMID: 34120810 DOI: 10.1016/j.ejso.2021.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/04/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. METHODS An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (≥5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). RESULTS LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND- (p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent significant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. CONCLUSION A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution.
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Affiliation(s)
- Hidde M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Songphol Malakorn
- Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Nagendra N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sergei Bedrikovetski
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jianliang Liu
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tim Kenyon-Smith
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brian K Bednarski
- Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Atsushi Ogura
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW, School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - Geerard L Beets
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Michelle L Thomas
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - George J Chang
- Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Morohashi H, Sakamoto Y, Miura T, Ichinohe D, Umemura K, Akaishi T, Sato K, Kuwata D, Yamazaki K, Wakiya T, Hakamada K. Effective dissection for rectal cancer with lateral lymph node metastasis based on prognostic factors and recurrence type. Int J Colorectal Dis 2021; 36:1251-1261. [PMID: 33527145 PMCID: PMC8119260 DOI: 10.1007/s00384-021-03870-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan.
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Daichi Ichinohe
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kotaro Umemura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Takanobu Akaishi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Daisuke Kuwata
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Keisuke Yamazaki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
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Inoue H, Sasaki K, Nozawa H, Kawai K, Murono K, Emoto S, Iida Y, Ishii H, Yokoyama Y, Anzai H, Sonoda H, Ozaki K, Yamauchi S, Sugihara K, Ishihara S. Therapeutic significance of D3 dissection for low rectal cancer: a comparison of dissections between the lateral pelvic lymph nodes and the lymph nodes along the root of the inferior mesenteric artery in a multicenter retrospective cohort study. Int J Colorectal Dis 2021; 36:1263-1270. [PMID: 33537876 DOI: 10.1007/s00384-021-03858-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE D3 dissection is the standard treatment modality for locally advanced low rectal cancer in Japan. The benefit of lateral pelvic lymph node (LPLN) dissection (LPLND) and lymph nodes along the root of inferior mesenteric artery (253 LN) dissection (253 LND) for low rectal cancer has often been studied separately, and few studies have investigated their benefit in the same cohort. This study aimed to clarify the therapeutic significance of dissection of the LPLN in comparison to that of dissection of the 253 LN for low rectal cancer. METHODS We retrospectively evaluated 3508 patients with treatment-naïve stage I-III low rectal cancer who underwent mesorectal excision between 1997 and 2012. They were identified from the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer database. The rates of metastasis, survival, and therapeutic value index (5-year overall survival (OS) rate multiplied by metastatic rate for lymph node metastasis) were compared between LPLN and 253 LN. RESULTS The rates of LPLN metastasis and 253 LN metastasis were 17.9% and 1.5%, respectively. The 5-year OS was significantly different between patients with and without LPLN metastasis (55.0% vs 85.5%, P < 0.0001) and between patients with and without 253 LN metastasis (36.2% vs 83.3%, P < 0.0001). The therapeutic value indexes of LPLN and 253 LN were 9.85 and 0.54, respectively. CONCLUSIONS LPLND may have more therapeutic value than 253 LND for patients with treatment-naïve low rectal cancer, although both the patients with LPLN metastasis and those with 253 LN metastasis remained to have poor prognosis.
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Affiliation(s)
- Hiroaki Inoue
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuuki Iida
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kousuke Ozaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinichi Yamauchi
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Ouchi A, Komori K, Kinoshita T, Oshiro T, Kunitomo A, Ito S, Abe T, Shimizu Y. Possibilities for and limits of upfront surgical strategy with lateral pelvic node dissection for low rectal cancer. Jpn J Clin Oncol 2021; 51:713-721. [PMID: 33479766 DOI: 10.1093/jjco/hyaa265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Metastatic lateral pelvic nodes represent an important cause of pelvic recurrence in low rectal cancer patients even after preoperative chemoradiotherapy. This study aimed to evaluate the prognostic benefit of an upfront lateral pelvic nodes dissection strategy. METHODS A total of 175 consecutive patients with stage II/III low rectal adenocarcinoma who underwent mesorectal excision with lateral pelvic nodes dissection between 1998 and 2013 were identified. Regional lateral pelvic nodes were categorized as LD2 nodes (internal iliac, hypogastric and obturator) and LD3 nodes (external iliac, common iliac, lateral sacral, presacral and sacral promontory) according to the current Japanese Society for Cancer of the Colon and Rectum classification. RESULTS Five-year cumulative risks of local recurrence and recurrence-free survival were 4.8% and 78.1% for stage II patients, and 11.8% and 61.7% for stage III patients, respectively. Among stage III patients, no differences were observed in cumulative risks of local recurrence (5 years: 9.3% vs 14.7%, P= 0.463) and recurrence-free survival (5 years: 65.1 vs 61.2%, P = 0.890) between lateral pelvic nodes (-) and LD2 (+) patients. In multivariate analyses, metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence (hazard ratioadj: 1.389; 95% confidence interval: 0.409-4.716) and recurrence-free survival (hazard ratioadj: 0.884; 95% confidence interval: 0.425-1.837). CONCLUSIONS Metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence and recurrence-free survival based on an upfront lateral pelvic nodes strategy. Lateral pelvic nodes can improve recurrence and survival outcomes in locally advanced low rectal cancer patients with metastatic lateral pelvic nodes.
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Affiliation(s)
- Akira Ouchi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Takashi Kinoshita
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Taihei Oshiro
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Aina Kunitomo
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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50
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Christou N, Meyer J, Combescure C, Balaphas A, Robert-Yap J, Buchs NC, Ris F. Prevalence of Metastatic Lateral Lymph Nodes in Asian Patients with Lateral Lymph Node Dissection for Rectal Cancer: A Meta-analysis. World J Surg 2021; 45:1537-1547. [PMID: 33543333 PMCID: PMC8026473 DOI: 10.1007/s00268-021-05956-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Rectal cancers occupy the eighth position worldwide for new cases and deaths for both men and women. These cancers have a high tendency to form metastases in the mesorectum but also in the lateral lymph nodes. The therapeutic approach for the involved lateral lymph nodes remains controversial. OBJECTIVE We performed a systematic review and meta-analysis to assess the prevalence of metastatic lateral lymph nodes in patients with lateral lymph node dissection (LLND) for rectal cancer, which seems to be a fundamental and necessary criterion to discuss any possible indications for LLND. METHODS Data sources-study selection-data extraction and synthesis-main outcome and measures. We searched MEDLINE, EMBASE and COCHRANE from November 1, 2018, to November 19, 2018, for studies reporting the presence of metastatic lateral lymph nodes (iliac, obturator and middle sacral nodes) among patients undergoing rectal surgery with LLND. Pooled prevalence values were obtained by random effects models, and the robustness was tested by leave-one-out sensitivity analyses. Heterogeneity was assessed using the Q-test, quantified based on the I2 value and explored by subgroup analyses. RESULTS Our final analysis included 31 studies from Asian countries, comprising 7599 patients. The pooled prevalence of metastatic lateral lymph nodes was 17.3% (95% CI: 14.6-20.5). The inter-study variability (heterogeneity) was high (I2 = 89%). The pooled prevalence was, however, robust and varied between 16.6% and 17.9% according to leave-one-out sensitivity analysis. The pooled prevalence of metastatic lymph nodes was not significantly different when pooling only studies including patients who received neoadjuvant treatment or those without neoadjuvant treatment (p = 0.44). Meta-regression showed that the pooled prevalence was associated with the sample size of studies (p < 0.05), as the prevalence decreased when the sample size increased. CONCLUSION The pooled prevalence of metastatic lateral lymph nodes was 17.3% among patients who underwent rectal surgery with LLND in Asian countries. Further studies are necessary to determine whether this finding could impact the therapeutic strategy (total mesorectal excision with LLND versus total mesorectal excision with neoadjuvant radiochemotherapy).
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Affiliation(s)
- Niki Christou
- Digestive Surgery Department, University Hospital of Limoges, 2 Avenue Martin Luther King, 87042, Limoges, France.
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland.
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland
- Unit of Surgical Research, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Alexandre Balaphas
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland
- Unit of Surgical Research, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Joan Robert-Yap
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland
- Unit of Surgical Research, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland
- Unit of Surgical Research, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 41211, Geneva 14, Switzerland
- Unit of Surgical Research, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
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