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What is the impact of systemic chemotherapy for lateral lymph nodes in patients with locally advanced low rectal cancer?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Systemic chemotherapy (SC) before surgery is a potential treatment to improve survival in patients with advanced rectal cancer. However, the impact of SC on lateral lymph nodes (LLNs) remains unclear.

Methods

A total of 78 patients with stage II/III low rectal cancer, who received 3-month oxaliplatin-based SC followed by LLN dissection (LLND) in principle, were analysed retrospectively. “Total lateral lymph node metastases (tLLNMs)” was defined as having either pathological LLNMs (pLLNMs) or lateral local recurrences (LLRs). Patients with the maximum short-axis size of LLNs ≥ 7 mm were classified into the swollen group (n = 21).

Results

In the total cohort, tLLNMs included 6 pLLNMs (7.7%) and 2 LLRs (2.6%). In the non-swollen group, no patients had pLLNMs, but one had LLR (1.8%). In the swollen group, pLLNMs and LLRs were detected in 6 (28.6%) and 1 (4.8%), respectively. The swollen group was an independent risk factor for tLLNMs (P < 0.001), leading to the significantly worse 5-year relapse-free survival (RFS) of 52.4% than the others.

Conclusion

For patients without swollen LLNs, SC could allow for omission both of lateral irradiation and LLND. For patients with swollen LLNs, the lateral local control was favourable after SC and LLND without chemoradiotherapy (CRT); however, oxaliplatin-based SC might be insufficient to improve survival, requiring more intensive chemotherapy. CRT should be indicated according to the other risk factors of central local recurrence, although the swollen LLNs should be removed.

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Availability of data and material

The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan

    Atsushi Ogura, Kay Uehara, Toshisada Aiba, Tomoki Ebata & Masato Nagino

  2. Division of Gastrointestinal Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Norifumi Hattori, Goro Nakayama & Yasuhiro Kodera

  3. Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan

    Osamu Maeda & Yuichi Ando

Authors
  1. Atsushi Ogura
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  2. Kay Uehara
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  3. Toshisada Aiba
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  4. Norifumi Hattori
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  5. Goro Nakayama
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  6. Osamu Maeda
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  7. Yuichi Ando
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  8. Yasuhiro Kodera
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  9. Tomoki Ebata
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  10. Masato Nagino
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Contributions

Study concepts: Kay Uehara, Atsushi Ogura; study design: Kay Uehara, Masato Nagino; data acquisition: Atsushi Ogura; data analysis and interpretation: Atsushi Ogura; drafted the work: Atsushi Ogura; revised the work critically for important intellectual content: Goro Nakayama, Tomoki Ebata, Kay Uehara, Yasuhiro Kodera and Yuichi Ando; final approval: all authors.

Corresponding author

Correspondence to Kay Uehara.

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Conflicts of interest

Ando Yuichi received commercial research grant from Yakult Honsha, Mochida Pharmaceutical, Taiho Pharmaceutical, Daiichi Sankyo, Sawai Pharmaceutical and Nippon Kayaku. And he also received honoraria from Yakult Honsha, Taiho Pharmaceutical, Daiichi Sankyo, Sawai Pharmaceutical and Nippon Kayaku. The other authors declare that they have no conflicts of interest.

Ethics approval

This study was approved by the local ethics committees of Nagoya University Hospital (reference No. 2019-0205).

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Informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Ogura, A., Uehara, K., Aiba, T. et al. What is the impact of systemic chemotherapy for lateral lymph nodes in patients with locally advanced low rectal cancer?. Int J Colorectal Dis 35, 2073–2080 (2020). https://doi.org/10.1007/s00384-020-03690-z

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  • DOI: https://doi.org/10.1007/s00384-020-03690-z

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