Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study |
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| Affiliation: | 1. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia;2. Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia;3. Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA;4. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;5. Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;6. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;7. GROW, School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands;8. Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands;9. Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands;1. National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;2. Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;3. Department of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland;4. Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, Basingstoke, UK;1. Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA;2. University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA;3. European Interbalkan Medical Center, Asklipiou 10, Pilea 555 35m, Thessaloniki, Greece;4. Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece;1. Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy;2. Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy;1. Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, 310008, China;2. Department of Head, Neck & Thyroid Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310000, China;3. Department of Radiology, The 903 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang, 310000, China;4. Department of Breast Surgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, 310000, China;1. Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark;2. Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark;3. Department of Clinical Physiology, Nuclear Medicine and PET, Herlev and Gentofte Hospital, Copenhagen, Denmark;4. Department of Radiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark;5. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia;6. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;7. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia |
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| Abstract: | BackgroundIn the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients.MethodsAn international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (≥5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group).ResultsLLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND- (p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent significant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups.ConclusionA LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution. |
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| Keywords: | Low rectal cancer Locally advanced rectal cancer Neoadjuvant (chemo)radiotherapy Lateral lymph nodes Lateral lymph node dissection |
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