Long-term Outcomes of Lower Rectal Cancer Patients Treated with Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection after Preoperative Radiotherapy or Chemoradiotherapy

• Sakamoto Wataru

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Ohki Shinji

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Onozawa Hisashi

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Okayama Hirokazu

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Endo Hisahito

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Fujita Shotaro

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Saito Motonobu

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Saze Zenichiro

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Momma Tomoyuki

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Takenoshita Seiichi

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

• Kono Koji

  Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University

Abstract

Objectives: The standard strategy for advanced rectal cancer (RC) is preoperative short-course radiotherapy (SCRT) /chemoradiotherapy (CRT) plus total mesorectal excision (TME) in Western countries; however, the survival benefit of adding chemotherapy to radiotherapy remains unclear. There is accumulating evidence that either SCRT/CRT or lateral pelvic lymph node dissection (LPND) alone may not be sufficient for local control of advanced RC. We herein retrospectively evaluated the clinical outcomes of patients who were treated by SCRT/CRT+TME+LPND, particularly focusing on the prognostic impact of lateral pelvic lymph node metastasis (LPNM). Methods: Patients diagnosed as having clinical Stage II and III lower RC who received SCRT/CRT+TME+LPND between 1999 and 2012 at our hospital were enrolled. Adverse events (AEs), surgery-related complications (SRC), and therapeutic effects were retrospectively analyzed. Results: Fifty cases (SCRT:25, CRT:25) were analyzed. No significant differences were observed in overall survival (OS), relapse-free survival (RFS), local recurrence (LR), AE, and SRC between the SCRT and CRT groups, although the pathological therapeutic effect was higher in the CRT group. The patients with LPNM showed significantly inferior 5-year OS and 5-year RFS than those without LPNM. Conclusions: There were no significant differences in OS, RFS, or LR between SCRT and CRT, although CRT had a significantly greater histological therapeutic effect. The prognosis of the pathological LPNM-positive cases was significantly poorer than that of pathological LPNM-negative cases.

Journal

• Journal of the Anus, Rectum and Colon

  Journal of the Anus, Rectum and Colon 5 (2), 129-136, 2021-04-28

  The Japan Society of Coloproctology

Keywords

• lateral pelvic lymph node dissection
• lateral pelvic node metastasis
• rectal cancer
• chemoradiotherapy
• radiotherapy

Details

• CRID: 1390006363720132352
• NII Article ID: 130008031068
• DOI: 10.23922/jarc.2020-054
• ISSN: 24323853
• Web Site: https://www.jstage.jst.go.jp/article/jarc/5/2/5_2020-054/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2022049250
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed