Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes-Reference-Cited by-同舟云学术

Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes

Published:2021-01-23 Issue:2 Volume:108 Page:205-213
ISSN:0007-1323
Container-title:British Journal of Surgery
language:en
Short-container-title:

Author:

Schaap D P¹^ORCID,Boogerd L S F²,Konishi T³,Cunningham C⁴,Ogura A⁵⁶,Garcia-Aguilar J⁷,Beets G L⁸,Suzuki C⁹,Toda S¹⁰,Lee I K¹¹^ORCID,Sammour T¹²,Uehara K³^ORCID,Lee P¹³¹⁴,Tuynman J B²,van de Velde C J H⁶,Rutten H J T¹¹⁵,Kusters M²,Kusters M,Tuynman J,Hompes R,Akiyoshi T,Konishi T,Nieuwenhuijzen G A P,Rutten H J T,Schaap D P,Iversen H,Martling A,Suzuki C,Meershoek-Klein-Kranenbarg E,Ogura A,Putter H,van de Velde C J H,Garcia-Aguilar J,Gollub M J,Aiba T,Ogura A,Uehara K,Aalbers A G J,Beets G L,Beets-Tan R G H,Maas M,Betts M,Cunningham C,Lee H X,Moore J,Sammour T,Thomas M,Wells T,Lee P,Solomon M J,Choi M H,Kim M K,Lee I K,Oh S N,Won D D,Hanaoka Y,Kuroyanagi H,Toda S,Tomizawa K,Rutten H,Brown K G,Lee P,Solomon M J,

Affiliation:

1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands

2. Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands

3. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

4. Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

5. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

6. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

7. Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, USA

8. Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands

9. Department of Radiology, Karolinska Institutet, Stockholm, Sweden

10. Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

11. Department of Surgery, Seoul St Mary’s Hospital, Catholic University of Korea, Seoul, Korea

12. Department of Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia

13. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

14. Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia

15. Maastricht University, GROW, School of Oncology and Developmental Biology, Maastricht, the Netherlands

Abstract

Abstract Background In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Methods Patients with low cT3–4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. Results More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Conclusion Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes. Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Link

https://academic.oup.com/bjs/article-pdf/108/2/205/41930293/znaa009.pdf

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