Hidde M Kroon1, Songphol Malakorn2, Nagendra N Dudi-Venkata3, Sergei Bedrikovetski3, Jianliang Liu4, Tim Kenyon-Smith4, Brian K Bednarski2, Atsushi Ogura5, Cornelis J H van de Velde6, Harm J T Rutten7, Geerard L Beets8, Michelle L Thomas4, Miranda Kusters9, George J Chang2, Tarik Sammour3. 1. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Hidde.Kroon@sa.giv.au. 2. Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA. 3. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia. 4. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 5. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 6. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 7. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; 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.
Abstract
BACKGROUND: In 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. METHODS: An 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). RESULTS: LLND + 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. CONCLUSION: A 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.
BACKGROUND: In 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. METHODS: An 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). RESULTS: LLND + 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. CONCLUSION: A 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.
Authors: Oliver Peacock; Naveen Manisundaram; Sandra R Dibrito; Youngwan Kim; Chung-Yuan Hu; Brian K Bednarski; Tsuyoshi Konishi; Nir Stanietzky; Raghunandan Vikram; Harmeet Kaur; Melissa W Taggart; Arvind Dasari; Emma B Holliday; Y Nancy You; George J Chang Journal: Ann Surg Date: 2022-07-15 Impact factor: 13.787