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Prognostic Impact of Lateral Pelvic Node Dissection on the Survival of Patients in Low Rectal Cancer Subgroups Based on Lymph Node Size

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lateral pelvic node (LPN) dissection (LPND) is considered a promising technique for treating low rectal cancer; however, there is insufficient evidence of its prognostic value. Using centrally reviewed preoperative pelvic magnetic resonance (MR) images, this study aimed to find the patient population who has benefited from LPND.

Patients and Methods

MR images of patients from 69 institutes with stage II–III low rectal cancer were reviewed by experienced radiologists. Recurrence-free survival (RFS), overall survival (OS), and short-term outcomes were measured.

Results

In total, 731 preoperative MR images were reviewed (excluding patients with short-axis LPN ≥ 10 mm). Of these, 322 underwent total mesorectum excision (TME) without LPND (non-LPND group), and 409 underwent TME with LPND (LPND group). Preoperative treatment was performed for 40% and 25% of patients in the non-LPND and LPND groups, respectively. The incidence of postoperative complications was higher in the LPND group (44.5%) than in the non-LPND group (33.2%; P = 0.002). Among patients with LPNs < 5 mm, OS and RFS curves were not significantly different between the groups. Among patients with LPNs ≥ 5 mm, the LPND group had significantly higher 5-year OS and RFS than the non-LPND group (OS: 81.9% versus 67.3%; RFS: 69.4% versus 51.6%). On multivariate analysis of LPN ≥ 5 mm cases, LPND was independently associated with RFS.

Conclusions

Despite the high incidence of postoperative complications, this study showed the prognostic impact of LPND on low rectal cancer patients with LPNs (≥ 5 mm, < 10 mm short axis) measured by experienced radiologists.

Trial registration UMIN-ID: UMIN000013919

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Acknowledgements

We thank the following doctors and clinical research coordinators who cooperated in this study: Koji Tokunaga, Shigeshi Kohno, Hirotsugu Nakai, Ayako Ono, and Toshiyuki Sato (Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital), and the doctors listed in the previous paper.26

Funding

K.H. received grants for research (regarding the treatment of rectal cancer) from Japan Society of Clinical Oncology, the Japanese Foundation for Research and Promotion of Endoscopy, Kondou Kinen Medical Foundation, and Senko Medical Instrument. For study design, data collection, data analysis, manuscript preparation, and publication decisions, there was no involvement of the funders. A.S.—Japan Society of Clinical Oncology, The Japanese Foundation for Research and Promotion of Endoscopy, Kondo Kinen Foundation, Senko Medical Instrument

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Authors and Affiliations

  1. Department of Surgery, Kyoto University Hospital, Kyoto, Japan

    Koya Hida MD, PhD, Daisuke Nishizaki MD, PhD, Atsuhiko Sumii MD, Ryosuke Okamura MD, PhD, Yoshiharu Sakai MD, PhD, FACS & Kenji Kawada MD, PhD

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Tsuyoshi Konishi MD, PhD, Tomohiro Yamaguchi MD, PhD & Takashi Akiyoshi MD, PhD

  3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Tsuyoshi Konishi MD, PhD

  4. Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan

    Tomonori Akagi MD, PhD

  5. Department of Gastroenterological Surgery, Kitano Hospital, Osaka, Japan

    Meiki Fukuda MD, PhD

  6. Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan

    Seiichiro Yamamoto MD, PhD

  7. Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan

    Shigeki Arizono MD, PhD

  8. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Mamoru Uemura MD, PhD, FACS

  9. Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan

    Hirotoshi Hasegawa MD, PhD, FRCS

  10. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Satoshi Morita PhD

  11. Department of Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan

    Masahiko Watanabe MD, PhD, FACS

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  1. Koya Hida MD, PhD
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  2. Daisuke Nishizaki MD, PhD
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On behalf of Japan Society of Laparoscopic Colorectal Surgery

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Correspondence to Koya Hida MD, PhD.

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Supplementary Information

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Univariate analysis for recurrence-free survival

Flow diagram illustrating patient selection.

Kaplan-Meir plots for local recurrence-free survival with a) LPNs <5 mm, and b) 5 mm ≤ LPN <10 mm

10434_2021_10312_MOESM4_ESM.jpg

Kaplan-Meir plots for recurrence-free survival stratified by preoperative treatment (Tx) and LPN size. a) Tx(+), LPN <5 mm; b) Tx(+), LPN ≥5 mm; c)Tx(-), LPN <5 mm; d) Tx(-), LPN ≥5 mm

Kaplan-Meir plots stratified by preoperative treatment and the cut-off line of 4 mm

Kaplan-Meir plots stratified by preoperative treatment and the cut-off line of 7 mm

10434_2021_10312_MOESM7_ESM.jpg

Kaplan-Meir plots for a) overall survival and b) recurrence-free survival in all patients with LPN ≥5 mm (i.e. including enlarged lymph nodes ≥10 mm)

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Hida, K., Nishizaki, D., Sumii, A. et al. Prognostic Impact of Lateral Pelvic Node Dissection on the Survival of Patients in Low Rectal Cancer Subgroups Based on Lymph Node Size. Ann Surg Oncol 28, 6179–6188 (2021). https://doi.org/10.1245/s10434-021-10312-7

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  • DOI: https://doi.org/10.1245/s10434-021-10312-7

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