Atsushi Ogura1,2,3, Tsuyoshi Konishi3,4, Chris Cunningham5, Julio Garcia-Aguilar4, Henrik Iversen6, Shigeo Toda7, In Kyu Lee8, Hong Xiang Lee8, Keisuke Uehara2, Peter Lee9, Hein Putter1, Cornelis J H van de Velde1, Geerard L Beets10, Harm J T Rutten11,12, Miranda Kusters11,13. 1. 1 Leiden University Medical Center, Leiden, the Netherlands. 2. 2 Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. 3 Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 4. 4 Memorial Sloan Kettering Cancer Center, New York, NY. 5. 5 Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom. 6. 6 Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. 7. 7 Toranomon Hospital, Tokyo, Japan. 8. 8 The Catholic University of Korea, Seoul St Mary's Hospital Seoul, Republic of Korea. 9. 10 Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia. 10. 11 The Netherlands Cancer Institute, Amsterdam, the Netherlands. 11. 12 Catharina Hospital, Eindhoven, the Netherlands. 12. 13 Maastricht University, Maastricht, the Netherlands. 13. 14 Amsterdam University Medical Centers, Location VUMC, the Netherlands.
Abstract
PURPOSE: Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS: Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS: On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). CONCLUSION: LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
PURPOSE: Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS: Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS: On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). CONCLUSION: LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: R G Beets-Tan; G L Beets; R F Vliegen; A G Kessels; H Van Boven; A De Bruine; M F von Meyenfeldt; C G Baeten; J M van Engelshoven Journal: Lancet Date: 2001-02-17 Impact factor: 79.321
Authors: Miranda Kusters; Geerard L Beets; Cornelis J H van de Velde; Regina G H Beets-Tan; Corrie A M Marijnen; Harm J T Rutten; Hein Putter; Yoshihiro Moriya Journal: Ann Surg Date: 2009-02 Impact factor: 12.969
Authors: M Kusters; A Slater; M Betts; R Hompes; R J Guy; O M Jones; B D George; I Lindsey; N J Mortensen; D R James; C Cunningham Journal: Colorectal Dis Date: 2016-11 Impact factor: 3.788
Authors: Thomas A Hope; Marc J Gollub; Supreeta Arya; David D B Bates; Dhakshinamoorthy Ganeshan; Mukesh Harisinghani; Kartik S Jhaveri; Zahra Kassam; David H Kim; Elena Korngold; Neeraj Lalwani; Courtney C Moreno; Stephanie Nougaret; Viktoriya Paroder; Raj M Paspulati; Jennifer S Golia Pernicka; Iva Petkovska; Perry J Pickhardt; Gaiane M Rauch; Michael H Rosenthal; Shannon P Sheedy; Natally Horvat Journal: Abdom Radiol (NY) Date: 2019-11