Lateral lymph node and its association with distant recurrence in rectal cancer: A clue of systemic disease |
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| Affiliation: | 1. University of Torino, School of Medicine, Department of Oncology, Digestive Surgery and Surgical Oncology, San Luigi University Hospital, Orbassano, Torino, Italy;2. Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgical Sciences, Molinette Hospital and University of Torino School of Medicine, Italy;3. AOU Città della Salute e della Scienza University Hospital, Unit of Clinical Epidemiology and CPO, Torino, Italy;4. Division of General Surgery, Fondazione Policlinico Universitario A Gemelli, Universita'' Cattolica del Sacro Cuore, Rome, Italy;5. Department of Surgery, San Raffaele Hospital, Milan, Italy;6. Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy;7. Polo Apparato Digerente e Sistema Endocrino-Metabolico - Area Chirurgica Addominale, Fondazione Policlinico Universitario "Agostino Gemelli" - Università Cattolica del Sacro Cuore, Rome, Italy;8. Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano, Italy;9. Advanced Biomedical Sciences Department, "Federico II" University, AOU "Federico II", Naples Italy;10. Colorectal Surgical Oncology, National Cancer Institute - IRCCS - G. Pascale Foundation, Napoli, Italy;11. Clinica Chirurgica, Azienda Ospedaliero-Universitaria Torrette di Ancona, Italy;12. Division of General Surgery, E. Agnelli Hospital, Pinerolo (Torino), Italy;13. Colorectal Surgery, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Italy;14. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy;15. National Cancer Institute, Research Centre, Giovanni Paolo II, Surgery Unit, Bari, Italy;p. Department of General Surgery, Azienda Ospedaliero-Universitaria Senese, Nuovo Policlinico Le Scotte, Siena, Italy;q. Surgical Oncology, Ospedale Treviglio - ASST Bergamo Ovest Piazza Meneguzzo, 1 - 24047 Treviglio (BG), Italy;1. Radiation Oncology, Campus Bio-Medico University, Rome, Italy;2. General Surgery, Campus Bio-Medico University, Rome, Italy;3. Geriatric Surgery, Campus Bio-Medico University, Rome, Italy;4. Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy;5. Radiation Oncology, University Tor Vergata, Rome, Italy;1. Division of Colorectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;2. Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;3. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea |
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| Abstract: | ![]()
We analyzed oncologic outcomes according to pre-/post-LPLN enlargement. Rectal cancer patients who underwent resection post-PCRT during 2008–2012 were enrolled. Magnetic resonance imaging pre-/post-PCRT were re-evaluated. LNs with short axis (SA) ≥7 mm pre-PCRT and ≥4 mm post-PCRT were defined as enlarged nodes. Of 798 patients enrolled, recurrence occurred in 55 (6.9%) local, 17 (2.1%) lateral, and 179 (22.4%) distal regions. Patients with LPLN SA ≥7 mm pre-PCRT showed worse local recurrence-free survival (RFS), lateral RFS, and distant RFS (p < 0.001, 0.002, and 0.005, respectively). LN shrinkage post-PCRT to SA<4 mm showed better 5-year local RFS (83.5% vs. 78.3%, p = 0.045), but distant RFS was similar irrespective of LN shrinkage to <4 mm. Among patients with pre-PCRT SA ≥7 mm, node shrinkage to SA<4 mm after PCRT presented with lower incidence of local recurrence but did not benefit in distant recurrence. Lateral node sampling did not improve local recurrence control, resulting in a 5-year local RFS of 75.4% in patients undergoing lateral node sampling and 83.2% in those not undergoing lateral node sampling (p = 0.722). Four (66.7%) patients had lateral recurrence in the same area of the enlarged nodes identified pre-PCRT. For patients assessed with pre-PCRT nodes ≥7 mm, response to PCRT did not guarantee better outcomes. |
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| Keywords: | Pelvic lymph nodes Recurrence Lymph node dissection Rectal cancer |
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