Less Than 12 Lymph Nodes in The Surgical Specimen after Neo-Adjuvant Chemo-Radiotherapy in Rectal Cancer: Five Years Survival Analysis

Abstract Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.

Download Full-text

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Journal of Gastrointestinal Oncology ◽

10.21037/jgo.2016.09.03 ◽

2016 ◽

Vol 7 (6) ◽

pp. 946-957 ◽

Cited By ~ 13

Author(s):

Jaiprakash Gurawalia ◽

Kapil Dev ◽

Sandeep P. Nayak ◽

Vishnu Kurpad ◽

Arun Pandey

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Tumor Regression ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Surgical Specimen

Download Full-text

The Influence of Neoadjuvant Treatment on the Number of Lymph Nodes on the Surgical Specimen in Mid and Low Rectal Cancer - A Retrospective Single-Centre Study

Chirurgia ◽

10.21614/chirurgia.114.2.207 ◽

2019 ◽

Vol 114 (2) ◽

pp. 207

Author(s):

Dragoş-Viorel Scripcariu ◽

Gianina-Vanda Moraru ◽

Ionuţ Huţanu ◽

Bogdan Filip ◽

Mihaela-Mădălina Gavrilescu ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Neoadjuvant Treatment ◽

Low Rectal Cancer ◽

Single Centre ◽

Surgical Specimen ◽

Centre Study ◽

Single Centre Study

Download Full-text

Fewer Than 12 Lymph Nodes Can be Expected in a Surgical Specimen After High-Dose Chemoradiation Therapy for Rectal Cancer

Diseases of the Colon & Rectum ◽

10.1007/dcr.0b013e3181dadeb4 ◽

2010 ◽

Vol 53 (7) ◽

pp. 1023-1029 ◽

Cited By ~ 43

Author(s):

J. H. Marks ◽

E. B. Valsdottir ◽

A. A. Rather ◽

I. C. Nweze ◽

D. A. Newman ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Chemoradiation Therapy ◽

High Dose ◽

Surgical Specimen

Download Full-text

Impact of Number of Nodes Retrieved on Outcome in Patients With Rectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.1.157 ◽

2001 ◽

Vol 19 (1) ◽

pp. 157-163 ◽

Cited By ~ 402

Author(s):

Joel E. Tepper ◽

Michael J. O’Connell ◽

Donna Niedzwiecki ◽

Donna Hollis ◽

Carolyn Compton ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Therapy ◽

Lymph Nodes ◽

Survival Rates ◽

Nodal Status ◽

Substantial Impact ◽

Surgical Specimen ◽

Node Negative ◽

Node Positive ◽

Time To Relapse

PURPOSE: We postulated that the pathologic evaluation of the lymph nodes of surgical specimens from patients with rectal cancer can have a substantial impact on time to relapse and survival. PATIENTS AND METHODS: We analyzed data from 1,664 patients with T3, T4, or node-positive rectal cancer treated in a national intergroup trial of adjuvant therapy with chemotherapy and radiation therapy. Associations between the number of lymph nodes found by the pathologist in the surgical specimen and the time to relapse and survival outcomes were investigated. RESULTS: Patients were divided into groups by nodal status and the corresponding quartiles of numbers of nodes examined. The number of nodes examined was significantly associated with time to relapse and survival among patients who were node-negative. For the first through fourth quartiles, the 5-year relapse rates were 0.37, 0.34, 0.26, and 0.19 (P = .003), and the 5-year survival rates were 0.68, 0.73, 0.72, and 0.82 (P = .02). No significant differences were found by quartiles among patients determined to be node-positive. We propose that observed differences are primarily related to the incorrect determination of nodal status in node-negative patients. Approximately 14 nodes need to be studied to define nodal status accurately. CONCLUSION: These results suggest that the pathologic assessment of lymph nodes in surgical specimens is often inaccurate and that examining greater number of nodes increases the likelihood of proper staging. Some patients who might benefit from adjuvant therapy are misclassified as node-negative due to incomplete sampling of lymph nodes.

Download Full-text

Cervical lymph node enlargement as the initial manifestation of rectal cancer

BMC Gastroenterology ◽

10.1186/s12876-021-01628-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tong-Hui Xie ◽

Peng Su ◽

Jian-Guo Hong ◽

Hui Zhang

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Clinical Manifestations ◽

Initial Symptom ◽

Cervical Lymph Nodes ◽

Supraclavicular Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background Colorectal cancer is a very common malignant tumor worldwide. The clinical manifestations of advanced colorectal cancer include the changes in bowel habits, hematochezia, diarrhea, local abdominal pain and other symptoms. However, the colorectal cancer with an initial symptom of cervical lymph node enlargement is extremely rare. In this article, we report a case of rectal cancer presenting with cervical lymph nodes enlargement as the initial symptom. Case presentation A 57-year-old woman was admitted to our hospital for cervical lymph node enlargement which was accidentally detected during physical examination. Computed tomography scan revealed multiple enlarged lymph nodes in the neck. Cervical ultrasound showed normal thyroid gland and multiple left supraclavicular lymph nodes enlargement. The patient underwent lymph nodes biopsy and pathologic results showed metastatic adenocarcinoma. The subsequent lower gastrointestinal endoscopy revealed a mucosal bulge lesion located at rectus and biopsy revealed adenocarcinoma. The patient underwent rectal cancer resection. She is alive with no evidence of recurrence or new tumors 2 years after surgery. Conclusions Cervical lymph node metastasis is a rare metastatic way in colorectal cancer. This is the first case of rectal cancer presenting with cervical lymph nodes metastases as the initial symptom. Surgical resection combined with postoperative chemotherapy improved long-term prognosis of the patient. This rare metastatic way of rectal cancer should be paid attention for clinicians.

Download Full-text

Pathological features of lymph nodes around inferior mesenteric artery in rectal cancer: a retrospective study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02264-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Chunhui Jiang ◽

Ye Liu ◽

Chunjie Xu ◽

Yanying Shen ◽

Qing Xu ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Lymph Nodes ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Anal Verge ◽

T Stage ◽

Pathological Type ◽

Nerve Invasion ◽

Independent Risk Factors

Abstract Objective This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging. Methods 485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed. Results A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. Conclusion Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications.

Download Full-text

T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

European Surgery ◽

10.1007/s10353-021-00714-y ◽

2021 ◽

Author(s):

Henry Ptok ◽

Frank Meyer ◽

Roland S. Croner ◽

Ingo Gastinger ◽

Benjamin Garlipp

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Nodes ◽

False Negative ◽

Cumulative Risk ◽

Distant Metastases ◽

Number Of Patients ◽

Tumor Stages ◽

The Impact

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

Download Full-text

Apparent diffusion coefficient cannot discriminate metastatic and non-metastatic lymph nodes in rectal cancer: a meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03986-8 ◽

2021 ◽

Author(s):

Alexey Surov ◽

Hans-Jonas Meyer ◽

Maciej Pech ◽

Maciej Powerski ◽

Jasan Omari ◽

...

Keyword(s):

Rectal Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Lymph Nodes ◽

Meta Analysis ◽

Adc Value ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Apparent Diffusion ◽

Adc Values

Abstract Background Our aim was to provide data regarding use of diffusion-weighted imaging (DWI) for distinguishing metastatic and non-metastatic lymph nodes (LN) in rectal cancer. Methods MEDLINE library, EMBASE, and SCOPUS database were screened for associations between DWI and metastatic and non-metastatic LN in rectal cancer up to February 2021. Overall, 9 studies were included into the analysis. Number, mean value, and standard deviation of DWI parameters including apparent diffusion coefficient (ADC) values of metastatic and non-metastatic LN were extracted from the literature. The methodological quality of the studies was investigated according to the QUADAS-2 assessment. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian, and Laird random-effects models with inverse-variance weights were used to account the heterogeneity between the studies. Mean DWI values including 95% confidence intervals were calculated for metastatic and non-metastatic LN. Results ADC values were reported for 1376 LN, 623 (45.3%) metastatic LN, and 754 (54.7%) non-metastatic LN. The calculated mean ADC value (× 10−3 mm2/s) of metastatic LN was 1.05, 95%CI (0.94, 1.15). The calculated mean ADC value of the non-metastatic LN was 1.17, 95%CI (1.01, 1.33). The calculated sensitivity and specificity were 0.81, 95%CI (0.74, 0.89) and 0.67, 95%CI (0.54, 0.79). Conclusion No reliable ADC threshold can be recommended for distinguishing of metastatic and non-metastatic LN in rectal cancer.

Download Full-text