scholarly journals AB046. Lymph node yield is not a reliable prognostic marker in anterior resection and abdominoperineal resection following neoadjuvant therapy for rectal cancer

2020 ◽  
Vol 4 ◽  
pp. AB046-AB046
Author(s):  
Johnathon Harris ◽  
Christina Fleming ◽  
Muhammad Fahad Ullah ◽  
Emma McNamara ◽  
Stephen Murphy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Prognostic Marker ◽  
Abdominoperineal Resection ◽  
Anterior Resection ◽  
Lymph Node Yield ◽  
Node Yield

scholarly journals P10: LYMPH NODE YIELD IS NOT A RELIABLE PROGNOSTIC MARKER IN ANTERIOR RESECTION AND ABDOMINOPERINEAL RESECTION FOLLOWING NEOADJUVANT THERAPY FOR RECTAL CANCER

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
J Harris ◽  
CA Fleming ◽  
MF Ullah ◽  
E McNamara ◽  
S Murphy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Abdominoperineal Resection ◽  
Anterior Resection ◽  
Prognostic Indicator ◽  
Disease Recurrence ◽  
Lymph Node Yield ◽  
Primary Surgery ◽  
Significant Difference ◽  
Node Yield

Abstract Introduction International guidelines recommend a minimum lymph node yield (LNY) of ≥12 for oncological resection in colorectal cancer (CRC). Neoadjuvant chemoradiotherapy (NACRT) decreases LNY, which questions its ability to provide accurate prognostic information. The consensus of this significance remains undetermined. This study aimed to investigate the significance of LNY on recurrence and survival following anterior resection and abdominoperineal resection with or without NACRT for rectal cancer. Method Prospectively collected data on patients diagnosed with rectal cancer in a tertiary referral centre was interrogated retrospectively. Patients were divided into primary surgery and NACRT groups. Univariable analysis was performed using Fisher's exact test, t-test, and x2 test, while multivariable analysis utilised a multiple regression model. Disease recurrence and survival was analysed with logrank test for Kaplan-Meier curves. Result 148 patients were included [56.1% (n=83) receiving NACRT]. The median LNY of the primary surgery group was 14 [interquartile range (IQR) 11-19] and for the NACRT group was 12 (IQR 8-14) (p <0.001). Disease recurrence was similar in both primary surgery and NACRT groups. There was a significant decrease in overall mortality in NACRT patients (p = 0.03), but there was no significant difference observed in recurrence or mortality amongst LNYs of <8, 8-11, and ≥12. Conclusion LNY less than 12 was not a negative prognostic indicator following NACRT and surgery for rectal cancer. Take-home message A lymph node yield of less than 12 is not a negative prognostic indicator in rectal cancer patients who receive neoadjuvant chemotherapy.

Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy

2016 ◽  
Vol 70 (7) ◽  
pp. 584-592 ◽  
Author(s):  
Zhaomin Xu ◽  
Mariana E Berho ◽  
Adan Z Becerra ◽  
Christopher T Aquina ◽  
Bradley J Hensley ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiation ◽  
Mixed Effects ◽  
Patient Factors ◽  
Lymph Node Yield ◽  
Factors Associated ◽  
Node Yield

AimsLymph node yield (LNY) is used as a marker of adequate oncological resection. The American Joint Committee on Cancer (AJCC) currently recommends that at least 12 nodes are necessary to confirm node-negative disease for rectal cancer. A LNY of 12 is not always achieved, particularly in patients who have undergone neoadjuvant treatment. This study attempts to examine factors associated with LNY and its prognostic impact following neoadjuvant chemoradiation in rectal cancer.MethodsThe 2006–2011 National Cancer Data Base was queried for patients with clinical stage I–III rectal cancer who underwent a proctectomy. Suboptimal LNY was defined as <12 lymph nodes examined. A mixed-effects multinomial logistic regression model was used to identify independent factors associated with LNY. Mixed-effects Cox proportional hazards models were used to estimate the adjusted effect of LNY on 5-year overall survival.Results25 447 patients met inclusion criteria. Overall, 62% of the cohort received neoadjuvant chemoradiation and 32% had suboptimal LNY. The median LNY for patients who received neoadjuvant therapy was 13 (IQR: 9–18) and for patients who did not receive neoadjuvant therapy was 15 (IQR: 12–21). After risk adjustment, there was a 3.5-fold difference in the rate of suboptimal LNY among individual hospitals (27%–95%). Suboptimal LNY was independently associated with an 18% increased hazard of death among patients who did not receive neoadjuvant treatment and a 20% increased hazard of death among those who did receive neoadjuvant treatment when controlled for adjuvant treatment, staging, proximal/distal margins and other patient factors.ConclusionsSuboptimal LNY is independently associated with worse overall survival regardless of neoadjuvant therapy, pathological staging and patient factors in rectal cancer. This finding underlies the importance and challenge of an optimal lymph node evaluation for prognostication, especially for patients receiving neoadjuvant therapy.

Lymph Node Yield Is a Less Reliable Prognostic Marker Following Neoadjuvant Chemoradiotherapy Compared to Primary Surgery for Rectal Cancer

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Johnathon P. Harris ◽  
Christina A. Fleming ◽  
Muhammad F. Ullah ◽  
Emma McNamara ◽  
Stephen Murphy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Marker ◽  
Neoadjuvant Chemoradiotherapy ◽  
Lymph Node Yield ◽  
Primary Surgery ◽  
Node Yield

Lymph node yield during surgery after neoadjuvant therapy compared to surgery without neoadjuvant therapy in patients with esophageal, gastric, pancreatic, or rectal carcinoma: systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Ulrich Ronellenfitsch ◽  
Nika Maximov ◽  
Juliane Friedrichs ◽  
Jorg Kleeff
Keyword(s):  
Systematic Review ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Surrogate Marker ◽  
Lymph Node Yield ◽  
Gastrointestinal Carcinomas ◽  
Node Yield

BACKGROUND The lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas and a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. OBJECTIVE This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the oncological surrogate marker lymph node yield in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant treatment compared to those operated without neoadjuvant therapy. METHODS Studies comparing oncological resection of esophageal, stomach, pancreatic and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in the electronic databases PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include number of harvested metastatic lymph nodes, operation time, postoperative complications, pTNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy as well as in defined subgroups (neoadjuvant chemotherapy, neoadjuvant radiotherapy, neoadjuvant chemoradiotherapy, and esophageal, gastric, pancreatic, and rectal cancer) will be compared. RESULTS As of October 2021, we started with the data collection. CONCLUSIONS This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the oncological surrogate marker lymph node yield in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant treatment compared to those operated without neoadjuvant therapy. CLINICALTRIAL This systematic review is registered at PROSPERO, ID: 218459.

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