Optimization of therapeutic strategies for selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in patients with rectal cancer with clinical suspected lateral lymph node metastasis

被引:1
作者
Liu, Yuan [1 ]
Bao, Mandoula [2 ]
Jiang, Yujuan [2 ]
Li, Feng [3 ,4 ]
Xing, Wei [1 ]
Yang, Zhufeng [1 ]
Liu, Qian [2 ]
机构
[1] Hebei Univ Chinese Med, Hebei Prov Hosp Chinese Med, Affiliated Hosp, Dept Surg, Shijiazhuang, Peoples R China
[2] Chinese Acad Med Sci & Peking Union Med Coll, Natl Clin Res Ctr Canc, Natl Canc Ctr, Dept Colorectal Surg,Canc Hosp, Beijing, Peoples R China
[3] Capital Med Univ, Beijing Friendship Hosp, Beijing Key Lab Canc Invas & Metastasis Res, Dept Gen Surg, Beijing, Peoples R China
[4] Natl Clin Res Ctr Digest Dis, Beijing, Peoples R China
来源
FRONTIERS IN ONCOLOGY | 2023年 / 13卷
关键词
safety; surgical indications; survival outcomes; lateral lymph node dissection; neoadjuvant chemoradiotherapy; PREOPERATIVE CHEMORADIOTHERAPY; MESORECTAL EXCISION; MULTICENTER; BENEFIT;
D O I
10.3389/fonc.2023.1271463
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Selective lateral lymph node (LLN) dissection with total mesorectal excision after neoadjuvant chemoradiotherapy (nCRT) is pointed out to reduce lateral compartment recurrence and to improve survival in patients with rectal cancer with LLN metastases. This study aimed to explore the safety, surgical indications, and survival outcomes of LLN dissection after nCRT.Methods: This multicenter retrospective study included patients with rectal cancer with clinical evidence of LLN metastases (n = 466) treated across three hospitals in China. Patients who underwent total mesorectal excision and LLN dissection were grouped into nCRT (n = 155) and non-nCRT (n = 291), respectively. Propensity score matching was used to minimize selection bias.Results: After matching, nCRT did not significantly increase the surgery duration, intraoperative blood loss or postoperative complications (P > 0.05). In a multivariate logistic regression analysis, poor/mucinous/signet adenocarcinoma (P = 0.042) and post-nCRT LLN short diameter >= 7 mm (P < 0.001) were independent risk factors for pathological LLN metastasis after nCRT. Overall survival (P < 0.001) and disease-free survival (P < 0.001) were significantly worse in patients with LLN metastasis, which was, however, not an independent risk factor for survival after eliminating confounders. Multivariate prognostic analysis of 40-patient subset with pathological LLN metastasis showed that distant metastasis, metastasis beyond the obturator or internal iliac region, and >= 2 LLN metastasis were independent predictors of poor overall survival.Conclusions: Selective LLN dissection after nCRT is safe and feasible with acceptable perioperative outcomes. Patients with a post-nCRT LLN short diameter >= 7 mm or poor/mucinous/signet adenocarcinoma should receive supplementary LLN dissection after nCRT. However, patients with distant metastasis, metastasis beyond the obturator or internal iliac region, and involvement of >= 2 LLN may not benefit from LLN dissection, and LLN dissection should be carefully considered in such patients.
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