Abstract
BackgroundThe effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer.MethodsData of 301 patients with lower rectal cancer (tumor’s lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups.ResultsSignificantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups.ConclusionsIn this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.
Highlights
The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established
The proportion of patients who were preoperatively diagnosed with positive central lymph node metastasis was 70.3% in the dissection group and 51.1% in the non-dissection group (p = 0.03); there was no significant difference in the proportion of patients with pathological stage III disease between the groups (p = 0.37)
Bilateral prophylactic LLND was a laparotomy-based procedure in all patients in the dissection group, and a significant difference was observed between the method of approach in the dissection and non-dissection groups
Summary
The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. We aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer. According to the Japanese Colorectal Cancer Treatment Guidelines [1], lateral lymph node dissection (LLND) is recommended for rectal cancers in which the tumor’s lower edge is present on the. Despite the recommendations and relevant developments, the effectiveness of LLND in treating patients with lower rectal cancer is still a subject of debate and has not been clearly established.
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