Preoperative Chemoradiotherapy Might Improve the Prognosis of Patients with Locally Advanced Low Rectal Cancer and Lateral Pelvic Lymph Node Metastases.

Abstract

Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced low rectal cancer (LALRC). However, the prognostic significance of CRT in patients with lateral lymph node metastasis (LLNM) is unknown. The present study aimed to examine the prognostic impact of preoperative CRT in patients with LALRC and LLNM. We retrospectively analyzed data for 73 patients with LALRC and LLNM who underwent total mesorectal excision and lateral lymph node dissection from 1985 to 2012. The patient population was divided into a CRT group (n=30) who received preoperative CRT and a surgery alone group (n=43) who were treated without CRT. The 5-year overall survival (OS), 5-year relapse-free survival (RFS), and 5-year local recurrence (LR) rates were significantly better in the CRT group (78.2, 72.1, and 3.5%, respectively) compared with the surgery alone group (41.1, 25.4, and 39.6%, respectively). There were fewer total, mesorectal, and LLNMs in the CRT group compared with the surgery alone group. Multivariate analysis showed that surgery without CRT was an independent predictor of poorer OS (hazard ratio [HR] 3.513, p=0.004), RFS (HR 2.696, p=0.021), and LR rates (HR 11.094, p=0.001). A total number of lymph node metastases ≥4 were also an independent predictor of poorer OS and RFS. Preoperative CRT might have a significant prognostic impact on patients with LALRC with LLNM treated with total mesorectal excision and lateral lymph node dissection.