scholarly journals Surgical Treatment of Low-Lying Rectal Cancer: Updates

2021 ◽  
Vol 37 (6) ◽  
pp. 395-424
Author(s):  
Cristopher Varela ◽  
Nam Kyu Kim
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Lymph Node Metastases ◽  
Tumor Regression ◽  
Inguinal Lymph Node ◽  
Treatment Options ◽  
Neoadjuvant Chemoradiotherapy ◽  
Anastomotic Complications ◽  
Node Metastases

Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

Treatment of inguinal lymph node metastases in rectal cancer

2019 ◽  
Vol 45 (2) ◽  
pp. e44
Author(s):  
J. Hagemans ◽  
J. Rothbarth ◽  
C. Verhoef ◽  
J. Burger
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Inguinal Lymph Node ◽  
Node Metastases

PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 144-144
Author(s):  
Jasper Groen ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Annelijn E Slaman ◽  
Sybren Meijer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Predictive Value ◽  
Neoadjuvant Chemoradiotherapy ◽  
Celiac Trunk ◽  
Pet Ct ◽  
Resection Specimen ◽  
Node Metastases ◽  
18F Fdg

Abstract Background Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy. Methods All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated. Results A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%. Conclusion The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group. Disclosure All authors have declared no conflicts of interest.

Detection of Lymphovascular Invasion in Vulvar Cancer by D2-40 (Podoplanin) as a Predictor for Inguinal Lymph Node Metastases

Onkologie ◽  
2009 ◽  
Vol 32 (12) ◽  
pp. 732-738 ◽  
Author(s):  
Michael Braun ◽  
Eva Wardelmann ◽  
Manuel Debald ◽  
Gisela Walgenbach-Bruenagel ◽  
Tobias Höller ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Lymphovascular Invasion ◽  
Vulvar Cancer ◽  
Inguinal Lymph Node ◽  
Node Metastases

scholarly journals Lateral Pelvic Lymph Node Metastases in Rectal Cancer: A Systematic Review

2019 ◽  
Vol 43 (12) ◽  
pp. 3198-3206 ◽  
Author(s):  
Y. Atef ◽  
T. W. Koedam ◽  
S. E. van Oostendorp ◽  
H. J. Bonjer ◽  
A. R. Wijsmuller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Pelvic Lymph Node ◽  
Lateral Pelvic Lymph Node ◽  
Node Metastases

P154 SAFETY AND ONCOLOGICAL EFFICACY OF BILATERAL RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Chao, Yin-Kai
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Metastases ◽  
Neoadjuvant Chemoradiotherapy ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Node Metastases

Abstract Aim We sought to evaluate the safety and oncological efficacy of bilateral recurrent laryngeal nerve (RLN) lymph node dissection (LND) in patients with esophageal squamous cell carcinoma (ESCC) who had undergone neoadjuvant chemoradiotherapy (nCRT). Methods The need to dissect RLN lymph nodes in patients who had undergone nCRT is controversial. No data are currently available on the clinical utility and implications of RLN nodal dissection in nCRT-treated patients with esophageal cancer. We retrospectively examined the records of ESCC patients who were judged to be ycN-RLN(-) following nCRT. Patients were divided into two groups according to the extent of LND (standard two-field LND [STL group] versus total two-field LND [TTL group]). Only lower mediastinal and upper abdominal lymph nodes were removed in the STL group. In addition to the standard procedure, patients in the TTL group underwent resection of upper mediastinal lymph nodes located along the bilateral RLN. Using propensity score matching, 29 pairs were identified and compared with regard to perioperative complications, lymph node metastases rates, overall survival (OS), and disease-specific survival (DSS). Results No significant intergroup differences were identified in terms of in-hospital mortality and morbidity. Metastases to the RLN lymph nodes were identified in 20.7% (6/29) of TTL patients, being the only site of lymph node metastases in three of them. TTL was associated with lower upper mediastinal lymph node recurrence rate(6.5%) compared with STL (21.5%, p=0.134), although the overall recurrence rate was similar (STL, 44.8% versus TTL, 46.4%). No significant intergroup differences were also evident with regard to 3-year DSS and OS rates. Conclusions RLN LND can be safely performed in ESCC patients who had undergone nCRT, ultimately resulting in an improved local control and should be practiced as part of the surgical routine.

An Intriguing Case: Malignant Mesothelioma Presenting as Inguinal Lymph Node Metastases

2004 ◽  
Vol 28 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Judy A. C. King ◽  
Catherine M. Listinsky ◽  
J. Allan Tucker
Keyword(s):  
Lymph Node ◽  
Malignant Mesothelioma ◽  
Lymph Node Metastases ◽  
Inguinal Lymph Node ◽  
Node Metastases
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