Michael K Turgeon1, Adriana C Gamboa1, Jessica M Keilson1, Jeffrey Maniko2, Lillias Maguire2, Katherine Hrebinko3, Jennifer Holder-Murray3, Jason T Wiseman4, Sherif Abdel-Misih4, Saif Hamdan5, Alexander T Hawkins5, Philip Bauer6, Matthew Silviera6, Shishir K Maithel1, Glen C Balch7. 1. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA. 2. Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA. 3. Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 4. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA. 5. Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 6. Department of Surgery, Section of Colon & Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. 7. Department of Surgery, Division of Colon & Rectal Surgery, Emory University, Atlanta, Georgia, USA.
Abstract
INTRODUCTION: Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. MATERIALS AND METHODS: Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). RESULTS: Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1-2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81-12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). CONCLUSIONS: Radiographic persistence of RLPN was not associated with worse survival in well-selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.
INTRODUCTION: Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. MATERIALS AND METHODS: Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). RESULTS: Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1-2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81-12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). CONCLUSIONS: Radiographic persistence of RLPN was not associated with worse survival in well-selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.
Authors: Dow-Mu Koh; Christopher George; Louis Temple; David J Collins; Paul Toomey; Ashraf Raja; Nicholas Bett; Sami Farhat; Janet E Husband; Gina Brown Journal: AJR Am J Roentgenol Date: 2010-06 Impact factor: 3.959
Authors: Atsushi Ogura; Tsuyoshi Konishi; Geerard L Beets; Chris Cunningham; Julio Garcia-Aguilar; Henrik Iversen; Shigeo Toda; In Kyu Lee; Hong Xiang Lee; Keisuke Uehara; Peter Lee; Hein Putter; Cornelis J H van de Velde; Harm J T Rutten; Jurriaan B Tuynman; Miranda Kusters Journal: JAMA Surg Date: 2019-09-18 Impact factor: 14.766
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: T Akiyoshi; S Toda; T Tominaga; K Oba; K Tomizawa; Y Hanaoka; T Nagasaki; T Konishi; S Matoba; Y Fukunaga; M Ueno; H Kuroyanagi Journal: BJS Open Date: 2019-07-25