Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer
Tóm tắt
To clarify the risk factors of lateral pelvic lymph node (LPLN) metastasis of rectal cancer, we examined associations between LPLN status and clinicopathological factors including LPLN status diagnosed by computed tomography (CT). We reviewed a total of 210 patients with advanced rectal cancer, of which the lower margin was located at or below the peritoneal reflection, who underwent preoperative CT with 5-mm-thick sections and lateral pelvic lymph node dissection at the National Cancer Center Hospital between February 1998 and March 2006. Forty-seven patients (22.4%) had LPLN metastasis. Multivariate analysis showed that LPLN status diagnosed by CT, pathological regional lymph node status, tumor location, and tumor differentiation were significant risk factors for LPLN metastasis. Among 45 patients with well-differentiated adenocarcinoma who were LPLN-negative and in whom CT had found no regional lymph node metastasis, none had LPLN metastasis. On the other hand, among 13 patients with moderate or less differentiated lower rectal adenocarcinoma who were LPLN-positive and in whom CT had revealed regional lymph node metastasis, 12 (92.3%) had LPLN metastasis. LPLN status diagnosed by CT, pathological regional LN status, tumor location, and tumor differentiation are significant risk factors for LPLN metastasis. Using these factors, patients can be classified as having a low or high risk of LPLN metastasis.
Tài liệu tham khảo
Fujita S, Yamamoto S, Akasu T, Moriya Y (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585
Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763
Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672
Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, Chang HJ, Lim SB, Choi HS, Park JG (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15:729–737
Yano H, Saito Y, Takeshita E, Miyake O, Ishizuka N (2007) Prediction of lateral pelvic node involvement in low rectal cancer by conventional computed tomography. Br J Surg 94:1014–1019
Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32:128–133
Moriya Y, Sugihara K, Akasu T, Fujita S (1995) Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer 31A:1229–1232
Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880
Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502
Moriya Y, Sugihara K, Akasu T, Fujita S (1995) Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma with special reference to loco-regional recurrence. Dis Colon Rectum 38:1162–1168
Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Miyoshi M, Kajiwara Y, Sato T, Shimazaki H, Hase K (2007) Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245:80–87
Arii K, Takifuji K, Yokoyama S, Matsuda K, Higashiguchi T, Tominaga T, Oku Y, Tani M, Yamaue H (2006) Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients. Langenbecks Arch Surg 391:449–454
Matsuoka H, Nakamura A, Masaki T, Sugiyama M, Nitatori T, Ohkura Y, Sakamoto A, Atomi Y (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27:3529–3533
Quadros CA, Lopes A, Araujo I, Fahel F, Bacellar MS, Dias CS (2006) Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy and blue dye for rectal adenocarcinoma staging: preliminary results. Ann Surg Oncol 13:1617–1621
Tada M, Endo M (1995) Ultrasonographic examination for lateral lymphatic spread and local recurrence of rectal cancer. Preoperative detection and evaluation. Dis Colon Rectum 38:1047–1052
Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783
Matsuoka H, Nakamura A, Masaki T, Sugiyama M, Takahara T, Hachiya J, Atomi Y (2003) A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma. Am J Surg 185:556–559
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, Williams GT (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377
Koh DM, Brown G, Temple L, Raja A, Toomey P, Bett N, Norman AR, Husband JE (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology 231:91–99
Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T (2001) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44:1274–1280
Syk E, Torkzad MR, Blomqvist L, Ljungqvist O, Glimelius B (2006) Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer. Br J Surg 93:113–119
Kim JC, Takahashi K, Yu CS, Kim HC, Kim TW, Ryu MH, Kim JH, Mori T (2007) Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 246:754–762