Is elective inguinal or external iliac irradiation during neoadjuvant (chemo)radiotherapy necessary for locally advanced lower rectal cancer with anal sphincter invasion?

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) correlates with relapse-free survival (RFS) and may be a predictor of recurrence in patients after curative surgery for colorectal cancer. This study aimed to analyze the long-term oncological outcomes of locally advanced lower rectal cancer treated with curative surgery after neoadjuvant chemoradiotherapy (nCRT) to examine the prognostic value of the NLR and to evaluate the fluctuation of pre- and post-CRT NLR as recurrence risk factors.Methods: Fifty-two patients who underwent curative surgery were enrolled between 2009 and 2016. A cut-off pre-CRT NLR of 3.20 was used based on receiver-operating characteristic curve analysis. The primary outcome was RFS. Factors influencing recurrence after treatment according to fluctuations between the pre- and post-CRT NLR were also analyzed.Results: Univariate analysis was performed using 17 clinicopathological factors thought to affect RFS. A significant difference was found in the pre-CRT NLR (hazard ratio [HR]: 7.626, 95% confidence interval [CI]: 2.760-21.06, p<0.0001), operation time (HR: 2.949, 95% CI: 1.137-7.646, p=0.0261), and pathological T stage (HR: 8.342, 95% CI: 2.458-28.306 p=0.0007). RFS according to the pre-CRT NLR using Kaplan–Meier analysis showed that the group with pre-CRT ≥3.20 had a lower 5-year RFS (p=0.001). A lower pre-CRT NLR resulted in a significantly higher recurrence rate, regardless of the increase or decrease in the pre- and post-CRT NLR.Conclusions: The pre-CRT NLR may be a predictor of prognosis in patients with locally advanced lower rectal cancer after nCRT.

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Lateral lymph node dissection reduces local recurrence of locally advanced lower rectal cancer in the absence of preoperative neoadjuvant chemoradiotherapy: A systematic review and meta-analysis

10.21203/rs.3.rs-42723/v2 ◽

2020 ◽

Author(s):

Xiang Gao ◽

Cun Wang ◽

Yong-Yang Yu ◽

Lie Yang ◽

Zong-Guang Zhou

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Local Recurrence ◽

Meta Analysis ◽

Clinical Stage ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Lower Rectal Cancer ◽

Node Dissection ◽

Lateral Lymph Node

Abstract Background: The role of lateral lymph node dissection (LLND) in the treatment of locally advanced lower rectal cancer remains controversial. The present study was conducted to compare total mesorectal excision (TME) with or without LLND among patients with lower rectal cancer in clinical stage II/III.Methods: PubMed, Embase, Ovid, Cochrane Library, Google Scholar, and the ClinicalTrials.gov databases were systematically searched for publications that compared TME with or without LLND among patients with lower rectal cancer in clinical stage II/III. Subgroup analysis was performed based on whether preoperative neoadjuvant chemoradiotherapy (nCRT) was undertaken. The hazard ratios (HR), relative risk (RR), and weighted mean difference (WMD) were pooled.Results: Twelve studies that included 4458 patients were identified in the current meta-analysis. Collected data demonstrated that TME with LLND was associated with significantly longer operation time (WMD 90.73 min, P<0.001), more intraoperative blood loss (WMD 303.20 mL, P<0.001), and postoperative complications (RR=1.35, P=0.02). Urinary dysfunction (RR 1.44, P=0.38), sexual dysfunction (RR 1.41, P=0.17), and postoperative mortality (RR=1.52, P=0.70) were similar between the two groups. No statistically significant differences were observed in OS (HR 0.93, P=0.62), DFS (HR 0.99, P=0.96), total recurrence (RR 0.98, P=0.83), lateral recurrence (RR 0.49, P=0.14) or distant recurrence (RR 0.95, P=0.78) between the two groups regardless the use of nCRT. LLND significantly reduced local recurrence rate of patients who did not receive nCRT (RR 0.71, P=0.004), while the difference was not significant when nCRT was performed (RR 0.70, P=0.36).Conclusions: Our study found out LLND could not significantly improve survival in locally advanced lower rectal cancer but could reduce the local recurrence in the absence of preoperative nCRT. The advantage of controlling local recurrence might be replaced with nCRT.Registration: The protocol for this meta-analysis was registered prospectively with PROSPERO (CRD42020135575) on May 16, 2019.

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Lateral lymph node dissection reduces local recurrence of locally advanced lower rectal cancer in the absence of preoperative neoadjuvant chemoradiotherapy: A systematic review and meta-analysis

10.21203/rs.3.rs-42723/v3 ◽

2020 ◽

Author(s):

Xiang Gao ◽

Cun Wang ◽

Yong-Yang Yu ◽

Dujanand Singh ◽

Lie Yang ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Local Recurrence ◽

Lymph Node Dissection ◽

Meta Analysis ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Lower Rectal Cancer ◽

Node Dissection ◽

Lateral Lymph Node

Abstract Background: The impact of lateral lymph node dissection (LLND) in locally advanced lower rectal cancer remains controversial. This study is to compare total mesorectal excision (TME) with or without LLND in lower rectal cancer cases of stage II/III.Methods: The electronic databases were systematically searched that compared TME with or without LLND among patients with lower rectal cancer in clinical stage II/III. Subgroup analysis was performed considering neoadjuvant chemoradiotherapy (nCRT). The hazard ratios (HR), relative risk (RR), and weighted mean difference (WMD) were pooled.Results: Twelve studies of 4458 patients of this meta-analysis demonstrate, LLND alone significantly reduced the local recurrence rate of patients who did not receive nCRT (RR 0.71, P=0.004), while the difference was not significant when combined with nCRT (RR 0.70, P=0.36). The analysis shows TME with LLND was associated with significantly longer operation time (WMD 90.73 min, P<0.001), more intraoperative blood loss (WMD 303.20 mL, P<0.001), and postoperative complications (RR=1.35, P=0.02). Whereas Urinary dysfunction (RR 1.44, P=0.38), sexual dysfunction (RR 1.41, P=0.17), and postoperative mortality (RR=1.52, P=0.70), were similar between these two groups. Statistically, no significant differences were observed in OS (HR 0.93, P=0.62), DFS (HR 0.99, P=0.96), total recurrence (RR 0.98, P=0.83), lateral recurrence (RR 0.49, P=0.14), or distal recurrence (RR 0.95, P=0.78) between these two groups regardless of whether nCRT was performed or not.Conclusions: The study shows LLND alone decreases the local recurrence without using nCRT irrespective of the survival advantage in locally advanced lower rectal cancer. The benefit of controlling local recurrence by LLND alone makes us reconsider the usage of nCRT with LLND.Registration: The protocol for this meta-analysis was registered prospectively with PROSPERO (CRD42020135575) on May 16, 2019.

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P-271 Feasibility of neoadjuvant chemotherapy with modified FOLFOX6 (combination chemotherapy of infusional 5-FU/l-Leucovorin and intermittent oxaliplatin) with bevacizumab in patients with locally advanced lower rectal cancer

Annals of Oncology ◽

10.1093/annonc/mdw199.261 ◽

2016 ◽

Vol 27 ◽

pp. ii78

Author(s):

C. Kosugi ◽

K. Koda ◽

K. Tanaka ◽

Y. Miyazawa ◽

K. Shuto ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Chemotherapy ◽

Combination Chemotherapy ◽

Locally Advanced ◽

Lower Rectal Cancer ◽

Modified Folfox6

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Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.72.1464 ◽

2017 ◽

Vol 35 (23) ◽

pp. 2631-2638 ◽

Cited By ~ 19

Author(s):

Naruhiko Ikoma ◽

Y. Nancy You ◽

Brian K. Bednarski ◽

Miguel A. Rodriguez-Bigas ◽

Cathy Eng ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Salvage Surgery ◽

Multidisciplinary Treatment ◽

Locally Advanced ◽

Preoperative Chemoradiotherapy ◽

Lower Rectal Cancer ◽

Mesorectal Excision ◽

Time To Recurrence ◽

The Impact

Purpose After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment. Patients and Methods Patients with locally advanced (cT3-4 or cN+) rectal cancer who were treated with preoperative chemoradiotherapy followed by total mesorectal excision at our institution during 1993 to 2008 were identified. We examined patterns of recurrence location, time to recurrence, treatment factors, and survival. Results A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-only recurrence (11.2 months) than in lung-only recurrence (18.2 months) or locoregional-only recurrence (24.7 months; P = .001). Salvage surgery was performed in 57% of patients with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence ( P < .001) but not in those with locoregional-only recurrence ( P = .353). Conclusion We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

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