Extended Lymph Node Dissection for Rectal Cancer with Radiologically Diagnosed Extramesenteric Lymph Node Metastasis
Tóm tắt
The purpose of this study is to review the clinical outcomes of patients who received extended lymph node dissection for radiologically diagnosed extramesenteric lymph node metastasis. The authors reviewed clinical characteristics, short-term operative outcomes, and long-term oncologic outcomes of 151 patients who had received total mesorectal excision plus extended lymph node dissection for the treatment of radiologically diagnosed extramesenteric lymph node metastasis. The positive predictive value of the radiologic diagnosis of extramesenteric lymph node metastasis was 86.4% for lateral nodes and 40.0% for para-aortic nodes. It showed improvement over time. Perioperative mortality occurred in 3 patients (2.0%) and morbidity in 31 patients (20.5%). Pathologic examinations revealed metastatic para-aortic lymph nodes in 43 patients (PA) and metastatic lateral pelvic nodes in 36 patients (LP), while in 21 patients, metastasis was found in both (LP + PA). Both cancer-specific survival (CSS) and disease-free survival (DFS) were significantly different according to the extent of node metastasis (CSS: P < .001; DFS: P < .001) and univariate and multivariate analyses for prognostic factors revealed that the lymph node status as to location was the only factor. Patients with extramesenteric lymph node metastasis may be a distinct subgroup with poor prognosis. Extended lymph node dissection may have a role for those patients. However, the optimal treatment strategy remains inconclusive, for which further clinical research is necessary.
Tài liệu tham khảo
Pahlman L. Management of carcinoma of the rectum, vol 1. 3rd ed. Philadelphia: Saunders Elsevier; 2008.
Hojo K, Koyama Y. The effectiveness of wide anatomical resection and radical lymphadenectomy for patients with rectal cancer. Jpn J Surg. 1982;12:111–6.
Koyama Y, Moriya Y, Hojo K. Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum—significant improvement of survival rate and decrease of local recurrence. Jpn J Clin Oncol. 1984;14:623–32.
Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg. 1998;383:409–15.
Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 1989;32:307–15.
Kim NK, Kim MJ, Park JK, Park SI, Min JS. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol. 2000;7:732–7.
Kim J, Beets G, Kim M, Kessels AG, Beets-Tan RG. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol. 2004;52:78–83.
Kim MJ, Huh YM, Park YN, Kim NK, Kim DJ, Chung JJ, et al. Colorectal mucinous carcinoma: findings on MRI. J Comput Assist Tomogr. 1999;23:291–6.
Engelen SM, Beets-Tan RG, Lahaye MJ, Kessels AG, Beets GL. Location of involved mesorectal and extramesorectal lymph nodes in patients with primary rectal cancer: preoperative assessment with MR imaging. Eur J Surg Oncol. 2008;34:776–81.
Lahaye MJ, Engelen SM, Kessels AG, de Bruine AP, von Meyenfeldt MF, van Engelshoven JM, et al. USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology. 2008;246:804–11.
Hojo K, Sawada T, Moriya Y. 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. 1989;32:128–33.
Matteo GD, Mascagni D, Tarroni D. Radical surgery for rectal cancer. J Surg Oncol Suppl. 1991;2:32–5.
Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum. 2001;44:1274–80.
Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.
Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.
Kim NK, Kim YW, Min BS, Lee KY, Sohn SK, Cho CH. Operative safety and oncologic outcomes of anal sphincter-preserving surgery with mesorectal excision for rectal cancer: 931 consecutive patients treated at a single institution. Ann Surg Oncol. 2009;16:900–9.
Kim J, Takahashi K, Yu C, Kim HC, Kim TW, Ryu MH, et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007; 246:754–62.
Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008; 15:729–37.
Enker W, Laffer U, Block G. Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg. 1979;190:350–60.
Glass R, Ritchie J, Thompson H, Mann C. The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy. Br J Surg. 1985;72:599–601.
Min BS, Kim NK, Sohn SK, Cho CH, Lee KY, Baik SH. Isolated paraaortic lymph-node recurrence after the curative resection of colorectal carcinoma. J Surg Oncol. 2008;97:136–40.
Leggeri A, Roseano M, Balani A, Turoldo A. Lumboaortic and iliac lymphadenectomy: what is the role today? Dis Colon Rectum. 1994;37:S54–61.
Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.