Predictive factors of pathological lateral pelvic lymph node metastasis in patients without clinical lateral pelvic lymph node metastasis (clinical stage II/III): The analysis of data from the clinical trial (JCOG0212) |
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| Institution: | 1. Department of Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;2. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan;3. JCOG Data Center and Operations Office, National Cancer Center Hospital, Tokyo, Japan;4. Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan;5. Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan;6. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Japan;7. Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan;8. Department of Surgery, Yokohama City University Medical Center, Kanagawa, Japan;9. Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan;10. Department of Surgery, Kanagawa Cancer Center, Yokohama, Japan;11. Department of Surgery, Kyoto Medical Center, Kyoto, Japan;12. Department of Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;13. Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan;14. Department of Colorectal Surgery, Tokyo Medical and Dental University, Japan;15. Division of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan;p. Department of Surgery, The Imperial Household Agency Hospital, Tokyo, Japan;q. Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan;1. Yonsei University College of Medicine, Seoul, South Korea;2. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea;3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea;4. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea;1. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan;2. JCOG Data Center, Operations Office, National Cancer Center, Tokyo, Japan;3. Department of Surgery, Kitasato University Hospital, Kanagawa, Japan;4. Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan;5. Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan;6. Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan;7. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan;8. Department of Surgery, Gastroenterological Centre, Yokohama City University, Yokohama, Japan;9. Department of Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan;10. Departments of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan;11. Department of Surgery, Keio University School of Medicine, Tokyo, Japan;12. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan;13. Department of Surgery, National Hospital Organization, Kyoto Medical Centre, Kyoto, Japan;14. Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan;15. Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan;p. Department of Surgery, Suita Municipal Hospital, Osaka, Japan;q. Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima, Japan;1. Department of Surgery, University of Florida, Gainesville, Florida;2. Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania;3. Department of Medicine, University of Florida, Gainesville, Florida;4. Department of Biostatistics, University of Florida, Gainesville, Florida;1. Department of Hematology, National Cancer Center Hospital East, Chiba, Japan;2. JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan;3. Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan;4. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan;5. Oita University, Oita, Japan;6. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan;7. Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan |
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| Abstract: | BackgroundMesorectal excision (ME) is the standard surgical procedure for lower rectal cancer. However, in Japan, total or tumor-specific ME with lateral pelvic lymph node dissection (LLND) is the standard surgical procedure for patients with clinical stages II or III lower rectal cancer, because lateral pelvic lymph node metastasis occasionally occurs in these patients. The aim of study was to elucidate the predictive factors of pathological lateral pelvic lymph node metastasis in patients without clinical lateral pelvic lymph node metastasis.MethodsData form the clinical trial (JCOG0212) was analyzed. The JCOG0212 was a randomized controlled trial to confirm the non-inferiority of mesorectal excision alone to mesorectal excision with lateral lymph node dissection for clinical stage II/III patients who don't have clinical lateral pelvic lymph node metastasis in terms of relapse free survival. This study was conducted at a multitude of institution33 major hospitals in Japan. Among the 351 patients who underwent lateral lymph node dissection in the JCOG0212 study, 328 patients were included in this study. Associations between pathological lateral pelvic lymph node metastasis and preoperative and postoperative factors were investigated. The preoperative factors were age, sex, clinical stage, tumor location, distance from anal verge, tumor size, and short-axis diameter of lateral pelvic lymph node on computed tomography and the postoperative factors were pathological T, pathological N, and histological grade.ResultsAmong the 328 patients, 24 (7.3%) had pathological lateral pelvic lymph node metastasis. In multivariable analysis of the preoperative factors, patient age (p = 0.067), tumor location (p = 0.025), and short-axis diameter of lateral pelvic lymph node (p = 0.002) were significantly associated with pathological lateral pelvic lymph node metastasis.ConclusionsPatient age, tumor location, and short-axis diameter of lateral pelvic lymph node were predictive factors of pathological lateral pelvic lymph node metastasis. |
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| Keywords: | Rectal cancer Lateral pelvic lymph node metastasis Lateral lymph node dissection |
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