Oncologic outcome of lateral pelvic lymph node metastasis in locally advanced rectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 661-661 ◽  
Author(s):  
HyungJin Kim ◽  
Gun Kim ◽  
Ri Na Yoo ◽  
Bong-Hyeon Kye ◽  
Hyeon-Min Cho
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Rectal Cancer Patient ◽  
Locally Advanced ◽  
Oncologic Outcome ◽  
Pelvic Lymph Node ◽  
Lateral Pelvic Lymph Node ◽  
The Mean ◽  
Group 2 ◽  
Group 1

661 Background: Lateral pelvic lymph node (LPLN) metastasis is a major cause of recurrence in patients with rectal cancer. This study investigates the oncologic outcome based on LPLN status after neoadjuvant chemoradiotherapy (nCRT). Methods: Between January 2009 and February 2013, 141 patients with rectal cancer received nCRT followed by curative radical surgery in our hospital. 16 patients were identified with LPLN before nCRT. These patients were categorized to two groups according to nCRT response evidenced by post-nCRT imaging studies with 5mm criteria. Group 1 included 7 patients who showed disappearance of LPLN after nCRT. Group 2 consisted of the patients identified with LPLN after nCRT. Results: The mean follow-up period was 35.6 ± 12.8 months. The mean overall survival (OS) period and 3-year OS rate for the patient with LPLN before nCRT was 56.0 ± 2.6 months and 93.3%, respectively. The mean relapse free survival period and 3-year RFS rate for the patient with LPLN before nCRT was 32.6 ± 5.7 months and 47.1%, respectively. The risk factors associated with RFS were ypN stage (P = 0.031), tumor location (P = 0.002), and postoperative CEA level (P = 0.022). Comparing RFS between Group 1 and 2, Group 1 tended to demonstrate longer RFS (P = 0.058). Analyzing oncologic outcome of two groups compared to the cohort population, group 1 showed similar oncologic outcome with ypTNM stage II. Group 2 demonstrated a tendency of worse oncologic outcome than ypTNM stage III (Group 1 vs. ypII P = 0.761 and Group 2 vs. ypIII P = 0.135). Conclusions: Preoperative LPLN status after nCRT seems to influence oncologic outcome in rectal cancer patient. If patients with LPLN metastasis before nCRT exhibit persistent LPLN metastasis after nCRT, they may require additional treatment.

scholarly journals Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review

2021 ◽  
Vol 37 (6) ◽  
pp. 382-394
Author(s):  
Min Chul Kim ◽  
Jae Hwan Oh
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Lateral Pelvic Lymph Node ◽  
Oncological Outcomes

Purpose: We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).Methods: We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.Results: The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).Conclusion: This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Outcomes of oxaliplatin-based adjuvant chemotherapy in pathologically lymph node positive (ypN+) rectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14664-e14664
Author(s):  
Ahmad Al Zahrani ◽  
James D. Brierley ◽  
Erin Diane Kennedy ◽  
Monika Krzyzanowska
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Distant Metastasis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Rank Test ◽  
Lymph Node Status ◽  
Curative Surgery ◽  
Group 2 ◽  
Group 1

e14664 Background: Standard therapy for locally advanced rectal cancer( LARC) with pre-operative chemoradiation(CRT) followed by curative surgery and adjuvant 5-flourouracil (5-FU) has resulted in a 5-year local relapse (LR) rate of less than 10% and incidence of distant metastases of about 36%. Accumulating data suggests that pathological lymph node status post CRT (ypN) is a major prognostic factor for long term outcomes in LARC .The role of adjuvant oxaliplatin-based therapy has not yet been well defined in ypN+ patients and is the focus of this study. Methods: Patients with ypN+ rectal cancer who underwent fluoropyrimidine-based preoperative CRT followed by curative surgery and received adjuvant oxaliplatin- (group 1) or fluoropyrimidine-based (group 2) chemotherapy at Princess Margaret Hospital were retrospectively reviewed.The study end point was comparison of three year disease free survival(DFS) and freedom from distant metastasis (FDM) in group 1 vs 2 using log-rank test. Results: Between 2003 and 2010, 25 pts in group 1 (adjuvant FOLFOX, n=23 and FOLFOX/bevacizumab, n=2) and 38 pts in group 2 ( adjuvant 5-FU/LV, n =37; capecitabine, n=1) were reviewed. Baseline characteristics were similar in both groups except more pts in group 2 had < 12 lymph nodes (LNs) retrieved (p=0.02), whereas more pts in group 1 were female (p=0.03)and had ypN2 vs ypN1 (p=0.01). Median follow-up was 33 months in group 1 and 38 months in group 2 (range: 3-86). Median age: 58 years. Male: 51, 80%. Five pts (8%) in the entire cohort experienced LR and 20 pts (31.7%) had distant metastasis. A trend toward better three-year DFS was observed in favour of oxaliplatin-based therapy (76% in group 1 vs. 51% in group 2; HR=0.4, 95%CI = 0.1-1.0; P=0.05). Corresponding three-year FDM rates were 83% and 58%, respectively (HR=0.23; 95% CI = 0.6-0.8; p= 0.01). In multivariate analysis, number of LNs retrieved of ≥12 and adjuvant oxaliplatin-based therapy were independent prognostic factors for improved DFS and FDM, respectively. Conclusions: Our analysis suggests that in ypN+ rectal cancer, addition of oxaliplatin to adjuvant therapy is associated with better outcomes. A prospective confirmatory randomized trial would be informative.

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