The diagnosis and oncological outcomes of obturator and internal iliac lymph node metastasis in middle-low rectal cancer: results of a multicenter Lateral Node Collaborative Group study in China

被引:1
作者
Huang, Fei [1 ]
Wei, Ran [1 ,2 ]
Zhou, Sicheng [3 ]
Mei, Shiwen [1 ]
Xiao, Tixian [1 ]
Xing, Wei [4 ]
Liu, Qian [1 ]
机构
[1] Chinese Acad Med Sci & Peking Union Med Coll, Dept Colorectal Surg, Natl Canc Ctr, Natl Clin Res Ctr Canc,Canc Hosp, 17 Panjiayuan Nanli, Beijing 100021, Peoples R China
[2] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Guangzhou, Guangdong, Peoples R China
[3] Peking Univ, Hosp 1, Dept Thyroid & Breast Surg, Beijing, Peoples R China
[4] Hebei Univ Chinese Med, Hebei Prov Hosp Chinese Med, Dept Gen Surg, Affiliated Hosp, Shijiazhuang, Peoples R China
关键词
Lateral lymph node; Pathological features; Survival; Rectal cancer; TOTAL MESORECTAL EXCISION; LOCAL RECURRENCE; SIZE CRITERIA; DISSECTION; CHEMORADIOTHERAPY; SURVIVAL;
D O I
10.1007/s12672-024-01500-4
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Lateral lymph node dissection (LLND) can decrease local recurrence to lateral compartments in middle-low rectal cancer, but pathological evidence for optimal surgical indications, especially after neoadjuvant (chemo)radiotherapy (nCRT), is lacking. This study aimed to identify the predictive factors and oncological outcomes for different LLN locations associated with pathological metastasis. Method In this multicenter study, patients from 19 centers who underwent total mesorectal excision (TME) with LLND for locally advanced mid-/low rectal cancer from January 2012 to December 2021 were included. Results All 566 included patients underwent TME with LLND surgery; 241 (37.4%) of the largest LLNs were located in the obturator area, and 403 (62.6%) of the largest LLNs were located in the internal iliac area. Multivariate analysis revealed that a short-axis size of 9 mm for the obturator area and 6 mm for internal iliac nodes constituted a reliable indicator of pathological LLN metastasis in non-CRT patients. In nCRT patients, a short-axis node size of 7 mm for obturator nodes and 4 mm for internal iliac nodes could be used to accurately predict pathological LLN metastasis. In contrast to pathological internal iliac node metastasis, pathological obturator node metastasis was associated with lower distant metastasis-free survival (DMFS) (P = 0.001), cancer-specific survival (CSS) (P = 0.043), and overall survival (OS) (P = 0.009), but lower lateral local recurrence-free survival (LRFS) (P > 0.05) was not statistically significant. Conclusions The obturator and internal iliac nodes may be two completely different types of LLNs, and the optimal cutoff value for predicting pathological LLN metastasis is inconsistent regardless of nCRT.
引用
收藏
页数:12
相关论文
共 24 条
[1]   Accuracy of High-Resolution Magnetic Resonance Imaging in Preoperative Staging of Rectal Cancer [J].
Akasu, Takayuki ;
Iinuma, Gen ;
Takawa, Masashi ;
Yamamoto, Seiichiro ;
Muramatsu, Yukio ;
Moriyama, Noriyuki .
ANNALS OF SURGICAL ONCOLOGY, 2009, 16 (10) :2787-2794
[2]   Lateral Lymph Node Size and Tumor Distance From Anal Verge Accurately Predict Positive Lateral Pelvic Lymph Nodes in Rectal Cancer: A Multi-Institutional Retrospective Cohort Study [J].
Bae, Jung Hoon ;
Song, Jumyung ;
Kim, Ji Hoon ;
Kye, Bong-Hyeon ;
Lee, In Kyu ;
Cho, Hyeon-Min ;
Lee, Yoon Suk .
DISEASES OF THE COLON & RECTUM, 2023, 66 (06) :785-795
[3]   Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes [J].
Bhangu, A. ;
Beynon, J. ;
Brown, G. ;
Chang, G. ;
Das, P. ;
Desai, A. ;
Frizelle, F. ;
Glynne-Jones, R. ;
Goldin, R. ;
Hawkins, M. A. ;
Heriot, A. ;
Laurberg, S. ;
Mirnezami, A. ;
Nicholls, R. J. ;
Sagar, P. ;
Tekkis, P. ;
Vuong, T. ;
Wilson, M. ;
Ali, S. M. ;
Antoniou, A. ;
Bose, P. ;
Boyle, K. ;
Branagan, G. ;
Burling, D. ;
Clark, S. K. ;
Colquhoun, P. ;
Crane, C. H. ;
Darzi, A. ;
Davies, M. ;
Delaney, C. P. ;
Dietz, D. ;
Dozois, E. J. ;
Duff, M. ;
Dziki, A. ;
Faria, J. ;
Fitzgerald, J. E. ;
Georgiou, P. ;
George, B. ;
George, M. L. ;
Gupta, A. ;
Guy, R. ;
Harji, D. P. ;
Harris, D. A. ;
Herzig, D. ;
Holm, T. ;
Hompes, R. ;
Jeys, L. ;
Jenkins, J. T. ;
Kiran, R. P. ;
Koh, C. E. .
BRITISH JOURNAL OF SURGERY, 2013, 100 (08) :E1-E33
[4]   Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212) A Multicenter, Randomized Controlled, Noninferiority Trial [J].
Fujita, Shin ;
Mizusawa, Junki ;
Kanemitsu, Yukihide ;
Ito, Masaaki ;
Kinugasa, Yusuke ;
Komori, Koji ;
Ohue, Masayuki ;
Ota, Mitsuyoshi ;
Akazai, Yoshihiro ;
Shiozawa, Manabu ;
Yamaguchi, Takashi ;
Bandou, Hiroyuki ;
Katsumata, Kenji ;
Murata, Kohei ;
Akagi, Yoshihito ;
Takiguchi, Nobuhiro ;
Saida, Yoshihisa ;
Nakamura, Kenichi ;
Fukuda, Haruhiko ;
Akasu, Takayuki ;
Moriya, Yoshihiro .
ANNALS OF SURGERY, 2017, 266 (02) :201-207
[5]   Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial [J].
Fujita, Shin ;
Akasu, Takayuki ;
Mizusawa, Junki ;
Saito, Norio ;
Kinugasa, Yusuke ;
Kanemitsu, Yukihide ;
Ohue, Masayuki ;
Fujii, Shoichi ;
Shiozawa, Manabu ;
Yamaguchi, Takashi ;
Moriya, Yoshihiro .
LANCET ONCOLOGY, 2012, 13 (06) :616-621
[6]   Japanese Society for Cancer of the Colon and Rectum (JS']JSCCR) guidelines 2019 for the treatment of colorectal cancer [J].
Hashiguchi, Yojiro ;
Muro, Kei ;
Saito, Yutaka ;
Ito, Yoshinori ;
Ajioka, Yoichi ;
Hamaguchi, Tetsuya ;
Hasegawa, Kiyoshi ;
Hotta, Kinichi ;
Ishida, Hideyuki ;
Ishiguro, Megumi ;
Ishihara, Soichiro ;
Kanemitsu, Yukihide ;
Kinugasa, Yusuke ;
Murofushi, Keiko ;
Nakajima, Takako Eguchi ;
Oka, Shiro ;
Tanaka, Toshiaki ;
Taniguchi, Hiroya ;
Tsuji, Akihito ;
Uehara, Keisuke ;
Ueno, Hideki ;
Yamanaka, Takeharu ;
Yamazaki, Kentaro ;
Yoshida, Masahiro ;
Yoshino, Takayuki ;
Itabashi, Michio ;
Sakamaki, Kentaro ;
Sano, Keiji ;
Shimada, Yasuhiro ;
Tanaka, Shinji ;
Uetake, Hiroyuki ;
Yamaguchi, Shigeki ;
Yamaguchi, Naohiko ;
Kobayashi, Hirotoshi ;
Matsuda, Keiji ;
Kotake, Kenjiro ;
Sugihara, Kenichi .
INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY, 2020, 25 (01) :1-42
[7]   Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer [J].
Hatano, Satoshi ;
Ishida, Hideyuki ;
Ishiguro, Tohru ;
Kumamoto, Kensuke ;
Ishibashi, Keiichiro ;
Mochiki, Erito ;
Tamaru, Junichi .
JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 2015, 45 (01) :35-42
[8]  
HEALD RJ, 1986, LANCET, V1, P1479
[9]   Optimal Size Criteria for Lateral Lymph Node Dissection After Neoadjuvant Chemoradiotherapy for Rectal Cancer [J].
Kawai, Kazushige ;
Shiratori, Hiroshi ;
Hata, Keisuke ;
Nozawa, Hiroaki ;
Tanaka, Toshiaki ;
Nishikawa, Takeshi ;
Murono, Koji ;
Ishihara, Soichiro .
DISEASES OF THE COLON & RECTUM, 2021, 64 (03) :274-283
[10]   Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection [J].
Kim, Tae Hyun ;
Jeong, Seung-Yong ;
Choi, Dong Hyun ;
Kim, Dae Yong ;
Jung, Kyung Hae ;
Moon, Sung Ho ;
Chang, Hee Jin ;
Lim, Seok-Byung ;
Choi, Hyo Seong ;
Park, Jae-Gahb .
ANNALS OF SURGICAL ONCOLOGY, 2008, 15 (03) :729-737