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Oncotarget. 2017 Aug 10;8(59):100724-100733. doi: 10.18632/oncotarget.20121. eCollection 2017 Nov 21.

Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer.

Author information

1
Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.
2
Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.
3
Department of Oncology/Hematology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.

Abstract

Background:

Although lateral pelvic lymph node (LPN) metastasis is a major cause of local recurrence in patients with rectal cancer, controversy still remains on the treatment of suspected LPN metastasis, "suspicious LPN". We aimed to determine the optimal treatment strategies for suspicious LPN, in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT).

Materials and Methods:

Of 377 patients who received preoperative CRT for rectal cancer between 2006 and 2013, 84 (22.3%) had suspicious LPNs on pretreatment MRI. Patients' characteristics, MRI findings, operative and pathologic findings, and oncologic outcomes were analyzed retrospectively.

Results:

Of 84 patients with suspicious LPNs, 61 showed good response to CRT on posttreatment MRI (short-axis LPN diameter < 5 mm). Among them, 31 patients underwent TME alone (group A), and 30 underwent TME plus LPND (group B). The remaining 23 patients had persistently suspicious LPNs on post-CRT MRI and underwent TME plus LPND (group C). Pathologic LPN metastasis was confirmed in five patients (16.7%) in group B and 15 (62.5%) in group C. Local recurrence developed in 7 (22.6%), 0 (0%), and 4 (17.4%) patients in groups A, B, and C, respectively. Five patients (16.1%) in group A developed in situ LPN recurrences. The 3-year disease-free survival rates were 53.7%, 74.2%, and 46.9% in groups A, B, and C, respectively.

Conclusions:

Study findings suggested that LPND cannot be omitted for patients with suspicious LPNs on pretreatment MRI even with good response to CRT. Findings from pretreatment MRI should be considered to determine whether LPND is indicated.

KEYWORDS:

lateral pelvic lymph node dissection; locally advanced rectal cancer; preoperative chemoradiation

Conflict of interest statement

CONFLICTS OF INTEREST The study has not been performed under any commercial sponsorship or grant.

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