Efficacy of lateral lymph node dissection for local control of rectal cancer: A multicenter study

BackgroundThis study aimed to evaluate the efficacy of lateral lymph node dissection (LLND) for rectal cancer by comparing the local control in patients with and without pathological lateral lymph node metastasis (LLNM).MethodsWe included 189 patients with rectal cancer who underwent total mesorectal excision and LLND at 13 institutions between 2017 and 2019. Patients with and without pathological LLNM were defined as the pLLNM (+) and (-) groups, respectively. Propensity score-matching helped to balance the basic characteristics of both groups. The incidences of local recurrence (LR) and lateral lymph node recurrence (LLNR) were compared between the groups.ResultsIn the entire cohort, 39 of the 189 patients had pathological LLNM. The 3-year LR and LLNR rates were 18.3% and 4.0% (p = 0.01) and 7.7% and 3.3% (p = 0.22) in the pLLNM (+) and (-) groups, respectively. After propensity score matching, the data from 62 patients were analyzed. No significant differences in LR or LLNR were observed between both groups. The 3-year LR and LLNR rates were 16.4% and 9.8% (p = 0.46) and 9.7% and 9.8% (p = 0.99) in the pLLNM (+) and (-) groups, respectively.ConclusionLLND would lead to comparable local control in the pLLNM (+) and (-) groups if the clinicopathological characteristics except for LLNM are similar. This study compared the incidence of local recurrence (LR) and lateral lymph node recurrence (LLNR) after total mesorectal excision and lateral lymph node dissection (LLND) between patients with and without pathological lateral lymph node metastasis (LLNM), using multicenter prospective data to assess the impact of LLND on the local control of rectal cancer. In the entire cohort, the 3-year LR and LLNR rates were 18.3% and 4.0% (p = 0.01) and 7.7% and 3.3% (p = 0.22) in the patients with and without pathological LLNM, while no significant differences in LR or LLNR were observed between both groups after propensity score matching. LLND would lead to comparable local control in the patients with and without pathological LLNM if the clinicopathological characteristics except for LLNM are similar.image