Lateral Node Research Articles

Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers

AbstractBackgroundExtramural vascular invasion (EMVI) is a bad prognostic feature in rectal cancer and cancers that remain EMVI positive after neoadjuvant therapy are at high risk for having involved circumferential resection margins. Conventional total mesorectal excision (TME) resections are inadequate in such cases and often lead to positive margins.MethodsWe propose a technique for the surgical management of locally advanced tumours with persistent EMVI after neoadjuvant therapy. Ten such tumours were resected using a “beyond TME” (b‐TME) approach with or without lateral pelvic lymph node dissection or seminal vesical excision.ResultsA b‐TME approach, customized to the anatomy of the tumour allowed for an R0 resection with a negative circumferential resection margin (CRM) in all 10 cases.ConclusionA tailored b‐TME approach can achieve good results in cases at high risk for CRM involvement.

Lymph node yield independently predicts local recurrence in papillary thyroid cancer

AbstractBackgroundLymph node yield (LNY) is a validated quality control parameter in colorectal cancer surgery, with >12 nodes reflecting an adequate oncological resection. No formal guidelines exist in the context of central and lateral compartment lymph node dissection for papillary thyroid cancer (PTC). This study aimed to investigate the association between LNY and regional recurrence in PTC patients, and to define a threshold LNY that indicates adequate compartmental lymphadenectomy.MethodsA retrospective analysis of patient data (1992–2022) was conducted using “The University of Sydney Endocrine Surgery Unit” database. Patients undergoing either prophylactic or therapeutic dissection of the central compartment or therapeutic dissection of the lateral compartment for PTC were included. Multivariate logistic regression analysis was performed to examine the relationship between nodal yield and local recurrence.ResultsOn multivariate analysis, a central LNY ≤3 was an independent adverse prognostic factor for central recurrence (odds ratios [OR] 2.19, 95% confidence intervals [CI] 1.15–4.17, and p = 0.018) and a lateral LNY ≤20 was independently predictive of lateral recurrence (OR 2.45, 95% CI 1.24–5.31, and p = 0.007).ConclusionsThis study highlights the association between LNY and local recurrence in PTC. Our findings suggest that minimum LNY thresholds (>3 for central and >20 for lateral) may serve as indicators of adequate dissection. Further research should validate these findings across healthcare centers.

Risk factors associated with lymph node metastasis in papillary thyroid cancer: a retrospective analysis based on 2,428 cases

BackgroundPapillary thyroid cancer (PTC) with lymph node metastasis (LNM) is associated with an increased risk of postoperative recurrence. Understanding the clinical characteristics of PTC patients can help surgeons assess the likelihood of LNM. This study aims to identify risk factors for LNM in PTC patients.MethodsWe retrospectively analyzed clinical data from 2,428 patients diagnosed with PTC who underwent initial thyroid surgery in our single center. Risk factors related to central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and skip metastasis were investigated by univariate and multivariate binary logistic regression analyses.ResultsUnivariate analysis revealed that the following factors were associated with an increased likelihood of CLNM (P<0.05): male gender, age < 45 years, maximal axial diameter (MAD) > 1 cm, body mass index (BMI) ≥ 28 kg/m² and multifocality. Univariate analysis also revealed that patients with age < 45 years, MAD > 1 cm, BMI ≥ 28 kg/m², multifocality, and CLNM demonstrated a higher propensity for LLNM (P<0.05). Lower pole tumors were more likely to have CLNM than upper pole tumors, while upper pole tumors were more prone to present LLNM (P<0.05) and skip metastasis (P<0.05). Multivariable binary logistic regression analysis identified that gender (odds ratio [OR], 1.732; 95% CI, 2.113–2.577; P < 0.001), age (OR, 1.905; 95% CI, 1.596–2.273; P < 0.001), MAD (OR, 4.639; 95% CI, 3.639–5.913; P < 0.001), and multifocality (OR, 1.860; 95% CI, 1.453–2.381; P < 0.001) were independent risk factors for CLNM and MAD (OR, 5.289; 95% CI, 3.777–7.404; P<0.001), multifocality (OR, 1.858; 95% CI, 1.248–2.766; P=0.002), and CLNM (OR, 5.030; 95% CI, 3.347–7.561; P<0.001) for LLNM.ConclusionDespite the overall postoperative recurrence rate in PTC patients is low, identifying risk factors such as male gender, age < 45 years, MAD > 1 cm, multifocality, and CLNM can help predict LNM. In specific cases, selective lymphadenectomy in the central or lateral neck area may be warranted.

ASO Author Reflections: Predictors of Pelvic Lymphocele Formation After Lateral Pelvic Node Dissection for Rectal Cancer.

ASO Author Reflections: Predictors of Pelvic Lymphocele Formation After Lateral Pelvic Node Dissection for Rectal Cancer.

Effect of autonomic nervous system resection extent on urinary dysfunction in robotic rectal cancer surgery

AbstractAimWe investigated whether autonomic nervous system resection during robotic rectal surgery contributes to urinary dysfunction and to what extent.MethodsThis retrospective cohort study included patients who underwent rectal surgery for primary rectal cancer between December 2011 and April 2021. We identified urinary dysfunction risk factors and examined the effect of autonomic nervous system resection extent on urinary dysfunction occurrence, with urinary dysfunction defined as a residual urine volume of >50 mL. Urinary dysfunction with no improvement over 1 y was defined as permanent urinary dysfunction.ResultsOf 1017 eligible patients, 78 (7.7%) required autonomic nervous system resection. Lateral lymph node dissection was performed in 357 patients (35.1%). Urinary dysfunction was observed in 102 patients (10.0%). We studied 32 (41.0%) of 78 patients who underwent autonomic nervous system resection and 82 (23.0%) of 357 patients who underwent lateral lymph node dissection presented with urinary dysfunction. Multivariate analysis revealed that lateral lymph node dissection and autonomic nervous system resection were significant predictors of urinary dysfunction. The urinary dysfunction incidence was notably higher in patients with autonomic nervous system unilateral total resection of at least one side than in those with bilateral preservation (65.4% vs. 28.8%, p < 0.01), and permanent urinary dysfunction exclusively occurred in these patients.ConclusionIn robotic surgery, autonomic nervous system resection and lateral lymph node dissection were independent risk factors for urinary dysfunction. Furthermore, the extent of autonomic nervous system resection may increase the risk of permanent urinary dysfunction.

The diagnosis and oncological outcomes of obturator and internal iliac lymph node metastasis in middle–low rectal cancer: results of a multicenter Lateral Node Collaborative Group study in China

BackgroundLateral lymph node dissection (LLND) can decrease local recurrence to lateral compartments in middle-low rectal cancer, but pathological evidence for optimal surgical indications, especially after neoadjuvant (chemo)radiotherapy (nCRT), is lacking. This study aimed to identify the predictive factors and oncological outcomes for different LLN locations associated with pathological metastasis.MethodIn this multicenter study, patients from 19 centers who underwent total mesorectal excision (TME) with LLND for locally advanced mid-/low rectal cancer from January 2012 to December 2021 were included.ResultsAll 566 included patients underwent TME with LLND surgery; 241 (37.4%) of the largest LLNs were located in the obturator area, and 403 (62.6%) of the largest LLNs were located in the internal iliac area. Multivariate analysis revealed that a short-axis size of 9 mm for the obturator area and 6 mm for internal iliac nodes constituted a reliable indicator of pathological LLN metastasis in non-CRT patients. In nCRT patients, a short-axis node size of 7 mm for obturator nodes and 4 mm for internal iliac nodes could be used to accurately predict pathological LLN metastasis. In contrast to pathological internal iliac node metastasis, pathological obturator node metastasis was associated with lower distant metastasis-free survival (DMFS) (P = 0.001), cancer-specific survival (CSS) (P = 0.043), and overall survival (OS) (P = 0.009), but lower lateral local recurrence-free survival (LRFS) (P > 0.05) was not statistically significant.ConclusionsThe obturator and internal iliac nodes may be two completely different types of LLNs, and the optimal cutoff value for predicting pathological LLN metastasis is inconsistent regardless of nCRT.Clinical trial registration The protocol of the current study was registered on ClinicalTrials.gov (NCT04850027), and the protocols were in accordance with the standards set by the World Medical Association Declaration of Helsinki.

Risk nomogram for papillary thyroid microcarcinoma with central lymph node metastasis and postoperative thyroid function follow-up

BackgroundThe treatment for papillary thyroid microcarcinoma (PTMC) is controversial. Central lymph node metastasis (CLNM) is one of the main predictors of recurrence and survival, accurate preoperative identification of CLNM is essential for surgical protocol establishment for PTMC. The objective of this study was to establish a nomogram to predict the possibility of CLNM in PTMC patients.MethodsA total of 3023 PTMC patients were randomly divided into two groups by a ratio of 7 to 3, the training group (n = 2116) and validation group (n = 907). The LASSO regression model and multivariate logistic regression analysis were performed to examine risk factors associated with CLNM. A nomogram for predicting CLNM was established and internally validated. Meanwhile, we follow-up the serum thyroid function FT3, FT4, TSH, Tg, TGAb and TPOAb in 789 PTMC patients for 4 years after surgery and compared the differences between the CLNM (+) and CLNM (-) groups, respectively.ResultsThe LASSO regression model and multivariate logistic regression analysis showed that younger age, lower BMI, being male, location in the lower pole, calcification, 1 ≥ diameter ≥ 0.5 cm, multifocality lesions, extra thyroidal extension (ETE), enlargement of central lymph node (ECLN), lateral lymph node metastasis (LLNM) and higher carcinoembryonic antigen were the ultimate risk factors for determining CLNM. A nomogram for predicting CLNM was constructed based on the influencing factors and internally validated. By establishing the prediction model, the AUC of CLNM in the training and validation groups were 0.73 (95% CI, 0.70-0.76) and 0.75 (95% CI, 0.71-0.79) respectively. Results of the DCA showed that the model is clinically useful when deciding on intervention in the most range of the threshold probability. A 4-year follow-up of thyroid function showed that FT3 and FT4 remained at stable levels after 3 months postoperative and were higher in the CLNM (+) group than in the CLNM (-) group. Hypothyroidism appeared predominantly within 3 months after surgery. The overall incidence of the CLNM (+) group and CLNM (-) groups were 16.46% and 12.04%, respectively.ConclusionThe nomogram model constructed in this study has a good predictive effect on CLNM in PTMC patients and provides a reasonable reference for clinical treatment.

Laparoscopic extraperitoneal approach for lateral lymph node dissection for patients with metachronous lateral pelvic lymph node metastases following surgery for rectal cancer: a case series and short-term outcomes.

There have been few reports of a totally extraperitoneal approach for laparoscopic lateral lymph node dissection (LLND) for patients with metachronous lateral pelvic lymph node metastases following surgery for rectal cancer. Therefore, this study reports the short-term outcomes of LLND via an extraperitoneal approach. A total of 10 patients underwent LLND through a laparoscopic extraperitoneal approach in our hospital since October 2018. Patients with suspected resectable lateral lymph node recurrence after surgery for rectal cancer on computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography CT (PET-CT) were selected for this procedure. Nine of the 10 cases were completed using this procedure, but one case was converted to an intraperitoneal approach. The median operative time was 231min, and the median estimated blood loss was 10ml. There was one case of wound infection, but no other postoperative complications were seen. In one patient, no metastases were found in the retrieved lymph nodes. The short-term outcomes of LLND through a laparoscopic extraperitoneal approach were acceptable. Because this procedure can be performed without violating the peritoneum, it is less invasive than the conventional intraperitoneal approach and is useful for metachronous lateral pelvic lymph node metastases.

Prognostic Impact of Skip Metastasis to the Lateral Lymph Nodes in Lower Rectal Cancer.

Some patients with lower rectal cancer develop "skip metastasis," in which lymph node metastasis occurs in the lateral but not the mesenteric lymph nodes. However, the prognostic impact of skip metastasis is unclear. This study aimed to determine the long-term prognosis of skip metastasis in lower rectal cancer. This retrospective study included patients with stage I-III lower rectal cancer who underwent total mesorectal excision and lateral lymph node dissection at our institution between 2000 and 2019. We investigated the association of lymph node metastasis with relapse-free and overall survival. Multivariate analyses were performed using Cox proportional hazards regression models. Of a total of 371 patients, 183 (49%) were negative for lymph node metastasis, 115 (31%) were positive for mesenteric lymph nodes only, 18 (5%) were positive for lateral lymph nodes only (skip metastasis), and 55 (15%) were positive for both mesenteric and lateral lymph nodes; the 5-year relapse-free survival rates were respectively 79.9%, 60.0%, 68.3%, and 32.7%, and 5-year overall survival rates were 96.6%, 90.0%, 85.6%, and 57.3%. Multivariable analysis revealed significant differences in relapse-free and overall survival between those positive for both mesenteric and lateral lymph nodes and those positive for lateral lymph nodes only (relapse-free survival, hazard ratio 2.30, p=0.048; overall survival, hazard ratio 3.50, p=0.030). In patients with lower rectal cancer who underwent total mesorectal excision and lateral lymph node dissection, those with skip metastasis had better relapse-free and overall survival than those with both mesenteric and lateral lymph node metastases.

Short-term outcomes of 47 selective laparoscopic lymph node dissection for rectal cancer: A retrospective study.

This study aims to analyze the safety, feasibility, and short-term oncology outcomes of selective laparoscope lateral lymph node dissection (LLND) with total mesorectal excision surgery. Between December 2019 and May 2023, LLND with total mesorectal excision surgery was performed in 47 selected patients with advanced rectal cancer. Surgical complications and 2-year oncology survival outcomes were analyzed in the study. All 47 procedures were technically successful without converting conversion to open surgery. The mean operation time was 200.6 minutes (135-321 minutes), and the mean estimated blood loss was 92.9 mL (range 10-2000 mL). The most common postoperative complications were anastomotic (8.5%, n = 4), ileus (6.4%, n = 3), and chyle leakage (4.3%, n = 2). Lateral pelvic lymph node metastases were found in 19 (40.4%) patients. When divided into lateral pelvic lymph node positive and negative groups, there was no significant impact on overall survival (94.4% vs 100%, Log-rank P = .596) and local recurrence-free survival (LFRS) (76.7% vs 89.6%, Log-rank P = .210), except disease-free survival (DFS) (58.3% vs 90.2%, Log-rank P = .005). Subgroup analysis showed similar short-term survival outcomes between the pN+ group and the internal iliac metastasis group (Log-rank P of overall survival, LFRS, and DFS were all ˃.05). LRFS and DFS in the obturator or external iliac metastasis group were worse than those in the internal iliac metastasis group when the follow-up time was extended (Log-rank P of LFRS and DFS were .05 and .063). Selective laparoscopy LLND for rectal cancer is safety and feasibility, and its complications are manageable. Oncology survival outcomes for lateral pelvic lymph node metastases limited to the internal iliac are similar to the pN+ stage; therefore, it should be treated positively.

Significance of Lateral Pelvic Lymph Node Dissection in Resectable Stage IV Low Rectal Cancer: Experience from a Single Center in Japan.

To investigate the significance of lateral pelvic lymph node dissection (LPLND) in resectable stage IV low rectal cancers, reviewing the treatment outcomes from a single cancer center dedicated to LPLND. Consecutive 56 patients with stage IV low rectal cancers who underwent primary tumor resection (PTR) between 2007 and 2022 were identified. Sixteen patients with non-curative PTR were excluded, and 40 with curative PTR were analyzed. The dominant metastatic organ was the liver in 30 (75.0%) patients, followed by the lung in 9 (22.5%). Seven (17.5%) patients had multiple organ metastasis. Five of 40 patients had cT1bN0 or cT2N0 disease, 8 did not receive LPLND for other reasons, and accordingly, 27 (67.5%) finally received LPLND. A total of 15 patients (37.5% of all 40 cases and 55.5% of 27 LPLND cases) had LPLN metastasis. Six (15.0%) patients had bilateral metastasis, and 6 (15.0%) had LD3 metastasis. Eight (20.0%) patients developed local recurrence (LR), and the 5Y-LR rate was 22.3%. Twelve (30.0%) patients underwent preceding chemotherapy before PTR, 26 (65.0%) received chemotherapy after PTR, and 23 (57.5%) achieved complete resection. Twelve (52.2%) of 23 patients developed distant recurrence after complete resection. 5Y-overall survival for all patients was 42.4%. A high rate of LPLN metastasis implies the significance of management for LPLN metastasis; meanwhile, an unsatisfactory complete resection rate and overall survival implies that LPLN metastasis in this cohort should be dealt with as a systemic disease.

Postoperative Morbidity and Factors Predicting the Development of Lymphoceles Following Lateral Pelvic Node Dissection for Rectal Cancer: A Cohort Study.

Lateral pelvic node dissection (LPLND) is indicated inthe surgical management of clinically significant pelvic lymphadenopathy associated with rectal malignancies. However, procedure-related morbidity, including the incidence and predisposing factors for lymphoceles arising in this setting have not been adequately evaluated. This retrospective single-institution study included 183 patients with nonmetastatic, lateral node-positive rectal cancer undergoing total mesorectal excision with LPLND between June 2014 and May 2023 to determine the incidence and severity of postoperative complications using the Clavien-Dindo system, with logistic regression performed to model a relationship between lymphocele-development and potentially-predictive variables. In this cohort, mean age was 45.3 ± 12.81 years, 62.8% were male, and 27.9% had body mass index ≥ 25kg/m2. Median tumor-distance from the verge was 3.0 (interquartile range [IQR] 1.0-5.0)cm. Following radiotherapy in 86.9%, all patients underwent surgery: 30.1% had open resection and 26.2% had bilateral LPLND. Median nodal-yield was 6 (IQR 4-8) per side. Postoperatively, 45.3% developed complications, with 18% consideredclinically significant. Lymphoceles, detected in 21.3%, comprised the single-most common sequelae following LPLND, 46.2%arising within 30 days of surgery and 33.3% requiring intervention. On multivariate analyses, obesity (hazard ratio [HR] 2.496; 95% confidence interval [CI] 1.094-5.695), receipt of preoperative radiation (HR 10.026; 95% CI 1.225-82.027), open surgical approach (HR 2.779; 95% CI 1.202-6.425), and number of harvested nodes (HR 1.105; 95% CI 1.026-1.190) were significantly associated with lymphocele-development. Pelvic lymphoceles and its attendant complications represent the most commonly encountered morbidity following LPLND for rectal cancer, with obesity, neoadjuvant radiotherapy, open surgery, and higher nodal-yield predisposing to their development.

ASO Visual Abstract: Postoperative Morbidity and Factors Predicting the Development of Lymphoceles following Lateral Pelvic Node Dissection for Rectal Cancer-A Cohort Study.

ASO Visual Abstract: Postoperative Morbidity and Factors Predicting the Development of Lymphoceles following Lateral Pelvic Node Dissection for Rectal Cancer-A Cohort Study.

Normal size of retropharyngeal lymph nodes in children on three dimensional magnetic resonance imaging.

Age-specific normal measurements or specific size criteria for retropharyngeal lymph nodes in children have not been defined. We aimed to determine the normal measurements and distribution of retropharyngeal lymph nodes on three-dimensional magnetic resonance imaging (3-D MRI) in children. In this retrospective study, we included 440 patients (213 girls) aged 0-17years who were admitted to our center with seizures and headaches and underwent brain and neck MRI with T2-sampling perfection with application-optimized contrasts using different flip angle evolution sequences. We evaluated the number, laterality, and level distribution of lateral and medial group lymph nodes according to the skull base-cervical vertebrae. For both groups, we measured the short and long diameters of the largest lymph node in the axial plane and the craniocaudal diameter in the sagittal plane. The short/long diameter ratios and volumes were determined. In 433 cases (98%), 1,554 lateral group lymph nodes were detected. Medial group lymph nodes were less common (7%). The lateral group was mostly bilateral, while the medial group was unilateral. Lateral group lymph nodes extended from the skull base-first cervical (C1) vertebral level to the C4, while the medial group extended from the C2 vertebral level to the C4. The mean axial short axis, axial long axis, and sagittal long axis diameters were 5.8mm, 10.1mm, and 15.5mm for the lateral group and 3.8mm, 7.6mm, and 10.8mm for the medial group, respectively. The findings of the study show that normally retropharyngeal lymph nodes are frequently seen in children and provide valuable information for lateral and medial lymph nodes depending on age.

Coagulation-related genes for thyroid cancer prognosis, immune infltration, staging, and drug sensitivity.

Thyroid cancer (THCA) is the most common endocrine tumor. Coagulation may be associated with the development of cancer, but its role in THCA patients is not yet clear. In this study, we determined the predictive value of coagulation biomarker D-dimer for THCA patient lateral lymph node metastasis (LLNM) through receiver operating characteristics (ROC) analysis and logistic regression analysis. Subsequently, this study used the TCGA database to identify coagulation-related molecular subtypes through consensus clustering analysis and compared their prognosis. We identified coagulation-related genes (CRGs) associated with prognosis in thyroid cancer through gene expression data and clinical information, and constructed a prognostic model by selecting the prognostic CRGs using LASSO regression. Patients were divided into high-risk and low-risk groups based on the median score. Subsequently, prognosis, clinical characteristics, gene mutation occurrence, immune infiltration, function, and drug sensitivity of the two groups were analyzed. We also constructed a nomogram combining the model and clinical features. Finally, the expression of the prognostic CRGs was validated by RT-qPCR. D-dimers had better performance in predicting LLNM(the area under the curve was 0.656 (95% CI 0.580-0.733), with a cut-off value of 0.065 mg/l), and D-dimer>0.065mg/l was an independent predictor of LLNM. Then, we selected 8 prognostic CRGs to construct a predictive model. The prognosis of low-risk group patients was significantly better than that of high-risk group (P<0.001). The results showed significant differences in clinical characteristics, gene mutation occurrence, immune infiltration, function, and drug sensitivity between the high-risk and low-risk groups. We validated by qPCR that these 8 prognostic CRGs were overexpressed in THCA cell lines. Overall, this study provided an in-depth exploration of the potential role of the coagulation in thyroid cancer and its clinical significance, offering a new theoretical basis and research direction for personalized therapy and prognostic evaluation.

Prognostic impact of lateral sentinel lymph node biopsy using indocyanine green on oncological outcomes for clinical stage II/III lower rectal cancer without suspected lateral lymph node metastasis.

Sentinel lymph node biopsy (SLNB) can detect occult nodal metastasis. We have previously reported the safety and feasibility of indocyanine green (ICG)-guided SLNB for clinical stage II/III lower rectal cancer (RC). However, little is known about the influence of lateral pelvic SLNB using ICG on oncological outcomes. The present study aimed to evaluate the prognostic impact of lateral pelvic SLNB on oncological outcomes compared with prophylactic lateral lymph node dissection (LLND). Participants comprised consecutive patients with clinical stage II/III lower RC who underwent lateral pelvic SLNB or prophylactic LLND (Non-SLNB) between January 2010 and December 2020. The primary outcome measure was the 5-year cumulative incidence of local recurrence (LR). Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS), local recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS). Among the 150 eligible patients included, 79 patients underwent lateral pelvic SLNB. Of those 79 patients, 4 patients who were SLNB-positive underwent LLND. LLND was omitted for the 75 patients who were SLNB-negative. Median follow-up was 61.0 months (range, 1.3-143.2 months). The overall recurrence rate was 30.7% (46 patients), with LR in 12.0% (18 patients). LR comprised lateral lymph node recurrence in 2.6% and central pelvic recurrence in 9.4%. No significant differences were seen between groups in terms of the frequency of LR or in CSS, OS, RFS, LRFS, or DRFS. Oncological outcomes were not different between the SLNB and Non-SLNB groups. ICG-guided SLNB appears promising as a method for determining indications for LLND.

Factors associated with occult lateral lymph node metastases in patients with clinically lymph node negative papillary thyroid carcinoma: a systematic review and meta-analysis

Factors associated with occult lateral lymph node metastases in patients with clinically lymph node negative papillary thyroid carcinoma: a systematic review and meta-analysis

Optimised treatment of patients with enlarged lateral lymph nodes in rectal cancer: protocol of an international, multicentre, prospective registration study after extensive multidisciplinary training (LaNoReC)

IntroductionInadequate treatment of enlarged lateral lymph nodes (LLNs) in rectal cancer patients is associated with an increased lateral local recurrence (LLR) risk, despite neoadjuvant treatment and total mesorectal excision (TME)...

Upfront surgery, neoadjuvant chemoradiotherapy, or neoadjuvant chemotherapy for rectal cancer with lateral lymph node metastasis: A multicenter MRI and lateral lymph node dissection study

AbstractAimThe purpose was to clarify the oncological outcomes of rectal cancer (RC) with lateral lymph node metastasis (LLNM) on high‐resolution MRI (HRMRI), considering preoperative treatments.MethodsTwo hundred and twelve patients, from 13 hospitals, diagnosed with RC with lateral lymph node dissection (LLND), between 2017 and 2019, were prospectively registered. LLNM was defined as a short‐axis size ≥5 mm. Ultimately, this study included 102 patients. Upfront surgery (Upfront), chemoradiotherapy (CRT), and neoadjuvant chemotherapy (NAC) were performed at each institution's discretion.ResultsSixty‐six (64.7%) had mesorectal fascia (MRF) involvement, 35 (34.3%) had extramural venous invasion, and 33 (32.4%) had bilateral LLNMs. A positive radial margin (RM1) was observed in nine patients (8.8%), and 35 (34.3%) had pathological LLNM (pLLNM). Overall, 3‐year relapse‐free survival (3yRFS) and local recurrence‐free survival (3yLRFS) were 69.6% and 92.9%. Upfront 3yRFS (N = 54), CRT (N = 23) and NAC (N = 25) constituted 62.9%, 82.6%, and 72.0%; 3yLRFS was 92.4%, 100%, and 88.0%. RM1 and pLLNM were significantly associated with LRFS (RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%; pLLNM negative vs. positive, 97.0% vs. 84.7%). 3yRFS Upfront non‐MRF (N = 21), post CRT non‐MRF (N = 15), and post NAC non‐MRF (N = 14) were 61.9%, 86.7%, and 100%; 3yLRFS was 90.2%, 100%, and 100%.ConclusionsGood local control of Upfront LLND for RC with LLNM was shown, but multidisciplinary treatments were required. CRT followed by surgery was preferable for RC with LLNM, but a radiation‐sparing strategy is promising for post NAC non‐MRF.

Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns.

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. 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. 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). 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.