OBJECTIVE: Lateral pelvic lymph node (LPLN) metastases are an important cause of preventable local failure in rectal cancer. The aim of this study was to evaluate clinical and oncological outcomes following magnetic resonance imaging (MRI)-directed surgical selection for lateral pelvic lymph node dissection (LPLND) after total neoadjuvant therapy (TNT). METHODS: A retrospective consecutive cohort analysis was performed of rectal cancer patients with enlarged LPLN on pretreatment MRI. Patients were categorized as LPLND or non-LPLND. The main outcomes were lateral local recurrence rate, perioperative and oncological outcomes and factors associated with decision making for LPLND. RESULTS: A total of 158 patients with enlarged pretreatment LPLN and treated with TNT were identified. Median follow-up was 20 months (interquartile range 10-32). After multidisciplinary review, 88 patients (56.0%) underwent LPLND. Mean age was 53 (SD±12) years, and 54 (34.2%) were female. Total operative time (509 vs 429 minutes; P =0.003) was greater in the LPLND group, but median blood loss ( P =0.70) or rates of major morbidity (19.3% vs 17.0%) did not differ. LPLNs were pathologically positive in 34.1%. The 3-year lateral local recurrence rates (3.4% vs 4.6%; P =0.85) did not differ between groups. Patients with LPLNs demonstrating pretreatment heterogeneity and irregular margin (odds ratio, 3.82; 95% confidence interval: 1.65-8.82) or with short-axis ≥5 mm post-TNT (odds ratio 2.69; 95% confidence interval: 1.19-6.08) were more likely to undergo LPLND. CONCLUSIONS: For rectal cancer patients with evidence of LPLN metastasis, the appropriate selection of patients for LPLND can be facilitated by a multidisciplinary MRI-directed approach with no significant difference in perioperative or oncologic outcomes.
OBJECTIVE: Lateral pelvic lymph node (LPLN) metastases are an important cause of preventable local failure in rectal cancer. The aim of this study was to evaluate clinical and oncological outcomes following magnetic resonance imaging (MRI)-directed surgical selection for lateral pelvic lymph node dissection (LPLND) after total neoadjuvant therapy (TNT). METHODS: A retrospective consecutive cohort analysis was performed of rectal cancer patients with enlarged LPLN on pretreatment MRI. Patients were categorized as LPLND or non-LPLND. The main outcomes were lateral local recurrence rate, perioperative and oncological outcomes and factors associated with decision making for LPLND. RESULTS: A total of 158 patients with enlarged pretreatment LPLN and treated with TNT were identified. Median follow-up was 20 months (interquartile range 10-32). After multidisciplinary review, 88 patients (56.0%) underwent LPLND. Mean age was 53 (SD±12) years, and 54 (34.2%) were female. Total operative time (509 vs 429 minutes; P =0.003) was greater in the LPLND group, but median blood loss ( P =0.70) or rates of major morbidity (19.3% vs 17.0%) did not differ. LPLNs were pathologically positive in 34.1%. The 3-year lateral local recurrence rates (3.4% vs 4.6%; P =0.85) did not differ between groups. Patients with LPLNs demonstrating pretreatment heterogeneity and irregular margin (odds ratio, 3.82; 95% confidence interval: 1.65-8.82) or with short-axis ≥5 mm post-TNT (odds ratio 2.69; 95% confidence interval: 1.19-6.08) were more likely to undergo LPLND. CONCLUSIONS: For rectal cancer patients with evidence of LPLN metastasis, the appropriate selection of patients for LPLND can be facilitated by a multidisciplinary MRI-directed approach with no significant difference in perioperative or oncologic outcomes.
Authors: Atsushi Ogura; Tsuyoshi Konishi; 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; Geerard L Beets; Harm J T Rutten; Miranda Kusters Journal: J Clin Oncol Date: 2018-11-07 Impact factor: 44.544
Authors: Panagiotis Georgiou; Emile Tan; Nikolaos Gouvas; Anthony Antoniou; Gina Brown; R John Nicholls; Paris Tekkis Journal: Lancet Oncol Date: 2009-09-18 Impact factor: 41.316
Authors: Renu R Bahadoer; Esmée A Dijkstra; Boudewijn van Etten; Corrie A M Marijnen; Hein Putter; Elma Meershoek-Klein Kranenbarg; Annet G H Roodvoets; Iris D Nagtegaal; Regina G H Beets-Tan; Lennart K Blomqvist; Tone Fokstuen; Albert J Ten Tije; Jaume Capdevila; Mathijs P Hendriks; Ibrahim Edhemovic; Andrés Cervantes; Per J Nilsson; Bengt Glimelius; Cornelis J H van de Velde; Geke A P Hospers Journal: Lancet Oncol Date: 2020-12-07 Impact factor: 41.316
Authors: Andrea Cercek; Campbell S D Roxburgh; Paul Strombom; J Joshua Smith; Larissa K F Temple; Garrett M Nash; Jose G Guillem; Philip B Paty; Rona Yaeger; Zsofia K Stadler; Kenneth Seier; Mithat Gonen; Neil H Segal; Diane L Reidy; Anna Varghese; Jinru Shia; Efsevia Vakiani; Abraham J Wu; Christopher H Crane; Marc J Gollub; Julio Garcia-Aguilar; Leonard B Saltz; Martin R Weiser Journal: JAMA Oncol Date: 2018-06-14 Impact factor: 31.777
Authors: Songphol Malakorn; Yun Yang; Brian K Bednarski; Harmeet Kaur; Y Nancy You; Emma B Holliday; Arvind Dasari; John M Skibber; Miguel A Rodriguez-Bigas; George J Chang Journal: Dis Colon Rectum Date: 2019-10 Impact factor: 4.585
Authors: Fiona G M Taylor; Philip Quirke; Richard J Heald; Brendan J Moran; Lennart Blomqvist; Ian R Swift; David Sebag-Montefiore; Paris Tekkis; Gina Brown Journal: J Clin Oncol Date: 2013-11-25 Impact factor: 44.544
Authors: Hye Jin Kim; Gyu-Seog Choi; Jun Seok Park; Soo Yeun Park; Seung Hyun Cho; Soo Jung Lee; Byung Woog Kang; Jong Gwang Kim Journal: Oncotarget Date: 2017-08-10
Authors: Anai N Kothari; Sandra R DiBrito; J Jack Lee; Abigail S Caudle; Mark W Clemens; Vijaya N Gottumukkala; Matthew H G Katz; Anaeze C Offodile; Abhineet Uppal; George J Chang Journal: Ann Surg Oncol Date: 2021-06-26 Impact factor: 5.344