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Oncological Impact of Lateral Lymph Node Dissection After Preoperative Chemoradiotherapy in Patients with Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy of selective lateral lymph node dissection (LLND) and the effect of preoperative chemoradiotherapy (PCRT) in patients with LLN ≥ 5 mm.

Methods

Patients who underwent PCRT for rectal cancer were classified: (A) total mesorectal excision (TME)-only with LLN < 5 mm (2001–2009, n = 474), (B) TME-only with LLN < 5 mm (2011–2016, n = 273), (C) TME-only with LLN ≥ 5 mm (2001–2009, n = 102), and (D) TME-LLND with LLN ≥ 5 mm (2011–2016, n = 69). Subgroup analysis was performed in patients with LLN ≥ 5 mm based on the reduction in LLN size to < 5 mm or not on restaging MRI after PCRT.

Results

Oncological outcomes did not differ between groups A and B. Group D had lower 3-year local recurrence (LR) (20.13% vs 5.39%, P = 0.0013) and higher relapse-free survival (RFS) (65.83% vs 77.11%, P = 0.0436) than group C, while the 3-year overall survival (OS) was not significantly different between the two groups (87.64% vs 93.53%, P = 0.0670). In patients with reduction of LLN size from ≥ 5 mm to < 5 mm, LLND significantly reduced LR than did TME alone, but there were no significant differences in survival outcomes. In patients without reduction of LLN size to < 5 mm, LLND reduced LR and improved RFS compared with TME alone.

Conclusions

Selective LLND reduced LR and improved RFS in patients with LLN ≥ 5 mm. Selective LLND reduced LR in patients with reduction of LLN size from ≥ 5 mm to < 5 mm after PCRT, and improved both LR and RFS in patients without reduction of LLN size to < 5 mm.

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Acknowledgment

This study was supported by a grant from the National Cancer Center (Number NCC1810181-1).

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Min Jung Kim M.D., Ji Won Park M.D. & Seung-Yong Jeong M.D., Ph.D.

  2. Cancer Research Institute, Seoul National University, Seoul, Republic of Korea

    Min Jung Kim M.D., Ji Won Park M.D. & Seung-Yong Jeong M.D., Ph.D.

  3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    George J. Chang M.D., M.S.

  4. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea

    Han-Ki Lim M.D., Sung Chan Park M.D., Dae Kyung Sohn M.D., Ph.D., Hee Jin Chang M.D., Ph.D., Dae Yong Kim M.D., Ph.D. & Jae Hwan Oh M.D., Ph.D.

  5. Biostatistics Collaboration Unit, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea

    Mi Kyung Song Ph.D.

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  1. Min Jung Kim M.D.
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Correspondence to Jae Hwan Oh M.D., Ph.D..

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Kim, M.J., Chang, G.J., Lim, HK. et al. Oncological Impact of Lateral Lymph Node Dissection After Preoperative Chemoradiotherapy in Patients with Rectal Cancer. Ann Surg Oncol 27, 3525–3533 (2020). https://doi.org/10.1245/s10434-020-08481-y

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  • DOI: https://doi.org/10.1245/s10434-020-08481-y

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