The expression of carcinoembryonic antigen mRNA in the lavage of the dissected area of the lateral lymph nodes influences the lateral recurrence of lower rectal cancer

Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival. Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020. Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection. Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.

Download Full-text

Exploratory analysis of lateral pelvic sentinel lymph node status for optimal management of laparoscopic lateral lymph node dissection in advanced lower rectal cancer without suspected lateral lymph node metastasis

BMC Cancer ◽

10.1186/s12885-021-08480-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masayoshi Yasui ◽

Masayuki Ohue ◽

Shingo Noura ◽

Norikatsu Miyoshi ◽

Yusuke Takahashi ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Lower Rectal Cancer ◽

Rectal Cancer Surgery ◽

Node Dissection ◽

Lateral Lymph Node ◽

Rectal Cancers ◽

Lateral Pelvic Lymph Nodes

Abstract Background Total mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiotherapy (RT) are standard treatment for lower cT3/4 rectal cancers in Eastern countries. In comparative studies, both TME + LLND and RT + TME yield good local control. Although Japanese guidelines recommend LLND for locally advanced rectal cancers below the peritoneal reflection, LLND dissection of clinically negative lateral pelvic lymph nodes (LPLN) is controversial, and laparoscopic TME + LLND is technically challenging and time-consuming. New optical instruments for laparoscopy allow easy perioperative sentinel lymph node (SLN) identification using ICG. The SLN concept may facilitate accurate diagnosis of LPLN involvement, and thus reduce LLND in laparoscopic rectal cancer surgery. Here we investigated lateral pelvic SLN navigation surgery for SLN detection during laparoscopic rectal cancer surgery. Methods This study included 21 patients with clinical StageII/III lower rectal cancer without LPLN enlargement, who underwent curative laparoscopic surgery. All patients underwent TME, followed by lateral SLN identification and biopsy using ICG, and then laparoscopic LLND. ICG fluorescence imaging was conducted using the laparoscopic near-infrared camera system. Results Lateral SLNs were successfully identified in 16 (76.2%) of the 21 patients. Among the 15 patients without SLN tumor metastasis, the dissected lateral non-SLNs were all negative. Conclusions A lack of metastasis in the lateral pelvic SLN seems to reflect a lack of metastases to all lateral LNs. Our present results suggest that this laparoscopic ICG-guided SLN strategy may be a low-risk and time-saving method to prevent laparoscopic LLND in cases with negative lateral pelvic lymph nodes.

Download Full-text

The Therapeutical Importance of Endoscopic Pathology versus Magnetic Resonance Imaging findings for T1 Rectal Cancer: A Case Report

International Surgery ◽

10.9738/intsurg-d-15-00099.1 ◽

2016 ◽

Author(s):

Eiji Hidaka ◽

Chiyo Maeda ◽

Kenta Nakahara ◽

Shoji Shimada ◽

Fumio Ishida ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Rectal Cancer ◽

Lymph Node ◽

Magnetic Resonance ◽

Lymph Nodes ◽

Cancer Cells ◽

Pelvic Lymph Node ◽

Lower Rectal Cancer ◽

Resonance Imaging ◽

Lateral Pelvic Lymph Node

Abstract Introduction: Preoperative image-based diagnosis is important for the treatment of rare cases of T1 lower rectal cancers with lateral pelvic lymph node (LLN) metastasis. We report a case of LLN metastasis in T1 lower rectal cancer diagnosed preoperatively via magnetic resonance imaging (MRI). Case presentation: A 65-year-old woman was admitted to our hospital because of abdominal pain. An endoscopic examination revealed a large laterally spreading tumor in the lower rectum, which was en bloc resected using endoscopic submucosal dissection. Pathological examination of the resected specimen showed deep invasion of the cancer cells into the submucosal layer and lymphovascular invasion. MRI revealed swollen perirectal lymph nodes (â¥5 mm) and a left LLN approximately 8 mm long. Laparoscopic abdominoperineal resection (Lap-APR) with left lateral pelvic lymph node dissection (LLND) was performed. Cancer cells were not seen in the resected material; however, 7 perirectal lymph nodes and 1 LLN of 47 lymph nodes contained metastatic cancer cells. Conclusion: We show that LLN metastasis in T1 lower rectal cancer can be preoperatively detected via MRI and successfully and safely treated via Lap-APR with left LLND.

Download Full-text

A multicenter phase I study on preoperative chemoradiotherapy with S-1 and CPT-11 for locally advanced lower rectal cancer (SAMRAI-1).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.503 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 503-503

Author(s):

Masafumi Noda ◽

Takeo Sato ◽

Kazushige Hayakawa ◽

Naohiro Tomita ◽

Norihiko Kamikonya ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Phase I ◽

Phase I Study ◽

Locally Advanced ◽

Preoperative Chemoradiotherapy ◽

Lower Rectal Cancer ◽

Level 3 ◽

Level 1 ◽

Level 2

503 Background: Preoperative chemoradiotherapy with 5-FU is a standard therapy for locally advanced lower rectal cancer. This therapy is useful for increasing local control rates and maintaining anal functions, but there is no evidence indicating that this therapy can extend survival. We performed a phase I study with the objective of developing a new chemoradiotherapy with irinotecan (CPT-11) and S-1, containing gimeracil, a dihydropyrimidine dehydrogenase inhibitor with radiosensitizing effect. Methods: Patients with locally advanced lower rectal cancer (T3-4, N0-2) of which the inferior border was located closer to the anal verge than to the peritoneal reflection were used for analysis. The radiation dose was 45 Gy in 25 fractions. The radiation field included the internal iliac, pararectal, and obturator lymph nodes in addition to the primary tumor and enlarged lymph nodes. S-1 was administered for five consecutive days and withdrawn for two consecutive days (administration: Days 1-5, 8-12, 22-26, and 29-33). The dose of S-1 (80, 100, 120 mg/day) was controlled in accordance with the body surface area. CPT-11 was administered on days 1, 8, 22, and 29. The initial dose of CPT-11 was 60 mg/m2 (Level 1), and the dose was increased gradually. Total mesorectal excision was performed 6-10 weeks after completion of the chemoradiotherapy. Results: 20 patients were enrolled. Excluding 2 patients who discontinued the study, 18 patients were subject to analysis. Dose-limiting toxicity (DLT) was not seen in 3 patients treated with CPT-11 at 80 mg/m2 (Level 2), but was seen in 3 of the 6 patients treated with CPT-11 at 90 mg/m2 (Level 3). DLT was seen in 3 other patients administered a Level 2 dose. At Level 2 or Level 3, DLTs, namely neutropenia, thrombocytopenia and diarrhea were seen. Level 2 was regarded as a maximum tolerated dose, and Level 1 as a recommended dose (RD). The pathological complete response rate was 28%, and the downstaging rate 56%. Conclusions: The results of the study suggest that the RD of CPT-11 is 60 mg/m2. We plan to perform a phase II study to evaluate the efficacy and safety of chemoradiotherapy with S-1 and CPT-11. Clinical trial information: UMIN000001639.

Download Full-text

Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyu162 ◽

2014 ◽

Vol 45 (1) ◽

pp. 35-42 ◽

Cited By ~ 10

Author(s):

S. Hatano ◽

H. Ishida ◽

T. Ishiguro ◽

K. Kumamoto ◽

K. Ishibashi ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Locally Advanced ◽

Lower Rectal Cancer ◽

Internal Iliac ◽

Prediction Of Metastasis

Download Full-text

The initial result of laparoscopic lateral pelvic lymph node dissection for lower rectal cancer after preoperative chemoradiotherapy

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.1.2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Triều Dương Triệu ◽

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Preoperative Chemoradiotherapy ◽

Pelvic Lymph Node Dissection ◽

Pelvic Lymph Node ◽

Lower Rectal Cancer ◽

Node Dissection ◽

Lateral Pelvic Lymph Node

Tóm tắt Đặt vấn đề: Đánh giá tính khả thi, an toàn, hiệu quả của phẫu thuật nội soi nạo vét hạch vùng chậu bên (Lateral Pelvic Lymph Node Dissection- LPLD) điều trị ung thư trực tràng thấp đã được hóa xạ trị tiền phẫu dài ngày. Phương pháp nghiên cứu: Nghiên cứu tiến cứu ở người bệnh (NB) ung thư trực tràng thấp được điều trị hóa xạ trị tiền phẫu dài ngày kết hợp phẫu thuật nội soi LPLD tại Khoa Phẫu thuật Hậu môn Trực tràng, Bệnh viện Trung ương Quân đội (TƯQĐ) 108 từ tháng 7/2018 - 02/2020. Kết quả: 14 người bệnh (10 nam, 4 nữ), tuổi trung bình 56,3 ± 10,5 tuổi (28 - 70). 100% u nằm dưới nếp phúc mạc. Giai đoạn (GĐ) trước mổ có 85,7% T4; 14,3% T3, 100% N+. Có 100% NB được hóa xạ trị (HXT) dài ngày trước mổ. GĐ sau HXT có 64,3% T3; 35,7% T2, 100% N+. Khoảng cách bờ dưới u đến mép hậu môn 4,7 ± 0,9cm (3-7). Có 5 NB vét hạch 2 bên, 9 NB vét hạch 1 bên. Thời gian phẫu thuật trung bình 174,3 phút (140 - 200), số lượng máu mất 84,3 ml (35 -200). Thời gian trung bình nạo vét hạch chậu 36,8 phút (15 - 65 phút). Tỉ lệ tai biến trong mổ: 1 NB chảy máu do tổn thương tĩnh mạch chậu trong được khâu cầm máu trong mổ. Tỉ lệ biến chứng chung: 1 NB hẹp miệng nối. Thời gian nằm viện trung bình 10,2 ngày (5 – 17). Tổng số hạch nạo vét toàn bộ là 14,1 hạch (5 - 33). Hạch chậu vét được là 7,6 hạch (3 -22). Tỉ lệ di căn hạch chậu bên: 42,8%. GĐ sau mổ có 35,7% T3; 50,0% T2; 7,1% T1; 7,1% T0; 42,8% N+. Chức năng sinh dục, tiết niệu lần lượt dựa theo câu hỏi thang điểm IIEF, IPSS trước mổ và sau mổ có rối loạn mức độ nhẹ. Kết luận: Phẫu thuật nội soi nạo vét hạch vùng chậu bên điều trị ung thư trực tràng thấp là khả thi, an toàn. Chức năng sinh dục, tiết niệu ít ảnh hưởng. Abstract Introduction: Assessment of the feasibility, safety, effectiveness of lateral pelvic lymph node dissection (LPLD) for lower rectal cancer after preoperative chemoradiotherapy (CRT). Materials and Methods: This was a prospective cohort study of lower rectal cancer treated by laparoscopic lateral pelvic lymph node dissection after preoperative chemoradiotherapy at the Department of Colon and Rectal Surgery, 108 Military Central Hospital between July 2018 and February 2020. Results: Fourteen patients (10 men and 4 women), with a mean (s.d) age of 56.3 (10.5) years. 100% the tumor was extraperitoneal. Pre-operative stage was 85.7 % T4; 14.3% T3, 100% N+. 100% has CRT for long term. After CRT were 64.3% T3; 35.7% T2, 100% N+. The distance from tumors to anal verge was 4,7 0,9cm (3-7). Bilateral LPLD was in 5 cases, and unilateral in 9 cases. The mean operation time was 174.3 minutes (range, 140 – 200), mean operative blood loss 84.3 ml (range, 35 to 200). The duration time mean for lymph node dissection was 36.8 minutes (15 – 65). Pre-operative accident: 1 bleeding due to injury to internal iliac veins has repair during the operation, post-operative complication: 1 patient has anastomotic stenosis. The length stay mean was 10,2 days (5 -17). The mean number of harvested lymph nodes was 14.1 (5-33). The number of pelvic lymph nodes harvested was 7,6 (3-22). The rate of positive lateral lymph nodes was 42.8%. Postoperative stage was 35.7 % T3; 50.0% T2; 7.1% T1; 42.8% N1. The sexual function as well as urinary function were evaluated according to perioperative and postoperation by using standard questionnaires of the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function ( IIEF) showed a little disorder. Conclusion: The LPLD technique is feasible, safe, effective for lower rectal cancer after preoperative chemoradiotherapy. Keywords: Lateral Pelvic Lymph Node Dissection – LPLD, rectal cancer, preoperative chemoradiotherapy.

Download Full-text