Japanese D3 Lymph Node Dissection in Low Rectal Cancer with Inferior Mesenteric Lymph Node Metastases

2014 ◽  
Vol 38 (10) ◽  
pp. 2724-2729 ◽  
Author(s):  
Mamiko Ubukata ◽  
Michio Itabashi ◽  
Shingo Kameoka
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Mesenteric Lymph Node ◽  
Lymph Node Metastases ◽  
Low Rectal Cancer ◽  
Node Dissection ◽  
Mesenteric Lymph ◽  
Node Metastases ◽  
D3 Lymph Node Dissection

Japanese D3 lymph node dissection in low rectal cancer with inferior mesenteric lymph node and/or lateral lymph node metastases.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 530-530
Author(s):  
Mamiko Ubukata ◽  
Michio Itabashi ◽  
Shimpei Ogawa ◽  
Tomoichiro Hirosawa ◽  
Yoshiko Bamba ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Node Dissection ◽  
Metastatic Lymph Nodes ◽  
Mesenteric Lymph ◽  
Metastatic Lymph ◽  
D3 Lymph Node Dissection

530 Background: The current Japanese Classification of Colorectal Carcinoma defines inferior mesenteric lymph nodes (IMLN) and lateral lymph nodes (LLN) as regional lymph nodes in rectal cancer. It states that these lymph nodes should be dissected when performing D3 dissection for rectal cancer. However, there is currently no consensus on the significance of Japanese D3 lymph node dissection in low rectal cancer. A retrospective study involving a large number of patients was conducted. Methods: The subjects were 2,743 patients registered in the multi-institutional registry of the Japanese Society for Cancer of the Colon and Rectum. The data were analyzed for outcomes in R0 cases with IMLN and/or LLN metastasis (IMLN(+)LLN(-) or IMLN(-)LLN(+) or IMLN(+)LLN(+)). Results: In the control group, 67 patients (2.7%) were considered positive for IMLN metastasis, 181 patients (7.4%) for LLN metastasis, and 34 patients (1.4%) for IMLN + LLN metastasis. The outcomes in the R0 cases with IMLN and/or LLN metastasis were 52.8% for 5-year RFS and 63.1% for 5-year OS, which were each better than for R1+R2 cases (5-year RFS 26.2%, p<0.0001; 5-year OS 30.5%, p<0.0001). Including only those with a total of seven or more metastatic lymph nodes, the outcomes in the R0 cases with IMLN and/or LLN metastasis were 53.6% for 5-year RFS and 64.9% for 5-year OS, which did not differ significantly from those for IMLN(-)LLN(-) cases (5-year RFS 54.4%, 5-year OS 55.2%) (RFS: p=0.9718, OS: p=0.4049). Conclusions: We confirmed that cases of IMLN and/or LLN metastasis in low rectal cancer tend to have a large total number of metastatic lymph nodes, but a good outcome can be expected if curative resection can be performed. These results demonstrate the value of radical Japanese D3 lymph node dissection in low rectal cancer with IMLN and/or LLN metastasis.

scholarly journals Report about the clinical meaning of patients with pathologic metastasis of lateral lymph nodes but no metastasis of mesenteric lymph nodes after lateral lymph node dissection in low rectal cancer

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Node Metastasis ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to investigate the clinical significance of lateral lymph node metastasis with no mesenteric lymph node metastasis after lateral lymph node dissection in middle and low rectal cancer .Methods Retrospective analysis was performed on the clinical data of 5 consecutive patients who were pathologically diagnosed with lateral lymph node metastasis, while mesenteric lymph node metastasis was not observed after laparoscopic lateral lymph node dissection underwent for advanced low rectal cancer from July 2017 to August 2019.Results All the 5 patients were successfully completed laparoscopic lateral lymph node dissection, and no cases were transferred to laparotomy.The mean age was 58.80±6.53 years, Two Miles surgeries and three Dixson surgeries were performed.Conclusion We found that some patients had lateral lymph node metastasis, while mesenteric lymph nodes had no metastasis after lateral lymph node dissection.This phenomenon suggests that lateral lymph nodes are one of the important metastasis pathways of low rectal cancer,a new N stage is needed to distinguish it from other types of lymph node metastasis.In addition, LLND is of great significance for the pathological diagnosis of lateral lymph nodes.

scholarly journals Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Mesenteric Lymph Nodes ◽  
Lateral Lymph Node ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer.Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017 to August 31, 2019 at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments.Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimal of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n=2 in the obturator region; n=3 in the iliac artery region).Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

scholarly journals Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Mesenteric Lymph Nodes ◽  
Lateral Lymph Node ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer.Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017 to August 31, 2019 at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments.Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimumal of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n=2 in the obturator region; n=3 in the iliac artery region).Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

scholarly journals Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Mesenteric Lymph Nodes ◽  
Lateral Lymph Node ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer.Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017 to August 31, 2019 at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments.Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimum of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n=2 in the obturator region; n=3 in the iliac artery region).Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

scholarly journals Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Mesenteric Lymph Nodes ◽  
Lateral Lymph Node ◽  
Mesenteric Lymph

Abstract ABSTRACT Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer. Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017 to August 31, 2019 at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments. Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimal of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n=2 in the obturator region; n=3 in the iliac artery region). Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

scholarly journals Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study

2021 ◽  
Author(s):  
E. Agger ◽  
V. Åkerlund ◽  
O. Ekberg ◽  
F. Jörgren ◽  
M. L. Lydrup ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cohort Study ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Node Metastases

Abstract Purpose Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). Methods Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. Results One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3–T4 ≤ 10 cm from the anal verge were analysed. Thirty (8.7%) patients with MRI-positive LLN were identified. Synchronous distant metastases were associated with MRI-positive LLN (p-value 0.019). Long-course chemoradiotherapy was clinical practice in cases of MRI-positive LLN. No differences in local (p-value 0.154) or distant (p-value 0.343) recurrence rates between MRI-positive LLN patients and MRI-negative patients were detected. Only four patients underwent lateral lymph node dissection (LLND). There was no significant difference in overall survival during follow-up between the MRI-negative (CI at 95%; 99–109 months) and MRI-positive group (CI at 95%; 69–108 months; p-value 0.14). Conclusion Lateral lymph node metastases present a challenging clinical situation. The present study shows that combination of neoadjuvant therapy and selective LLND is an applicable strategy in cases of MRI-positive LLN.

scholarly journals Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Mesenteric Lymph Nodes ◽  
Lateral Lymph Node ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer. Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017, to August 31, 2019, at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments. Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimum of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n = 2 in the obturator region; n = 3 in the iliac artery region). Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

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