BACKGROUND: Although chemoradiotherapy followed by radical surgery without lateral lymph node dissection is the current standard treatment in rectal cancer patients, recent studies have demonstrated the benefits of adding lateral lymph node dissection to total mesorectal excision in patients with suspected lateral lymph node metastasis. However, the optimal indication for lateral lymph node dissection after chemoradiotherapy has not been determined. OBJECTIVE: This study aimed to establish the optimal indication for lateral lymph node dissection after chemoradiotherapy in patients with rectal cancer. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single referral hospital. PATIENTS: A total of 279 rectal cancer patients who underwent chemoradiotherapy followed by radical surgery between 2007 and 2018 were retrospectively enrolled. MAIN OUTCOME MEASURES: The largest lateral lymph nodes on computed tomography were retrospectively assessed and compared with the pathological results of dissected lateral lymph nodes and recurrences in lateral lymph node areas. RESULTS: The incidence of lateral lymph node metastasis after chemoradiotherapy was estimated to be 9.3%. Although patients with lateral lymph node metastasis frequently developed distant recurrence, 40.4% survived for more than 5 years without recurrence. An analysis of the lateral lymph node sizes showed that lateral lymph node sizes ≥ 8 mm before chemoradiotherapy was the optimal criterion for lateral lymph node dissection, with a sensitivity and specificity of 92.3% and 78.7%, respectively. Using this criterion, 72.0% of the patients could be spared lateral lymph node dissection. LIMITATIONS: Owing to the retrospective nature of the present study, the selection of patients who underwent lateral lymph node dissection was biased. CONCLUSION: The optimal indication for lateral lymph node dissection was lateral lymph node size ≥ 8 mm before chemoradiotherapy. Cancer could be eradicated in more than 30% of patients with lateral lymph node metastasis by dissecting metastatic lateral lymph nodes. See Video Abstract at http://links.lww.com/DCR/B428 .
BACKGROUND: Although chemoradiotherapy followed by radical surgery without lateral lymph node dissection is the current standard treatment in rectal cancerpatients, recent studies have demonstrated the benefits of adding lateral lymph node dissection to total mesorectal excision in patients with suspected lateral lymph node metastasis. However, the optimal indication for lateral lymph node dissection after chemoradiotherapy has not been determined. OBJECTIVE: This study aimed to establish the optimal indication for lateral lymph node dissection after chemoradiotherapy in patients with rectal cancer. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single referral hospital. PATIENTS: A total of 279 rectal cancerpatients who underwent chemoradiotherapy followed by radical surgery between 2007 and 2018 were retrospectively enrolled. MAIN OUTCOME MEASURES: The largest lateral lymph nodes on computed tomography were retrospectively assessed and compared with the pathological results of dissected lateral lymph nodes and recurrences in lateral lymph node areas. RESULTS: The incidence of lateral lymph node metastasis after chemoradiotherapy was estimated to be 9.3%. Although patients with lateral lymph node metastasis frequently developed distant recurrence, 40.4% survived for more than 5 years without recurrence. An analysis of the lateral lymph node sizes showed that lateral lymph node sizes ≥ 8 mm before chemoradiotherapy was the optimal criterion for lateral lymph node dissection, with a sensitivity and specificity of 92.3% and 78.7%, respectively. Using this criterion, 72.0% of the patients could be spared lateral lymph node dissection. LIMITATIONS: Owing to the retrospective nature of the present study, the selection of patients who underwent lateral lymph node dissection was biased. CONCLUSION: The optimal indication for lateral lymph node dissection was lateral lymph node size ≥ 8 mm before chemoradiotherapy. Cancer could be eradicated in more than 30% of patients with lateral lymph node metastasis by dissecting metastatic lateral lymph nodes. See Video Abstract at http://links.lww.com/DCR/B428 .
Authors: Tania C Sluckin; Sanne-Marije J A Hazen; Karin Horsthuis; Regina G H Beets-Tan; Corrie A M Marijnen; Pieter J Tanis; Miranda Kusters Journal: Insights Imaging Date: 2022-10-20