Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

被引：10

作者：

Sluckin, Tania C. ^{[1
,2
,3
]}

Hazen, Sanne-Marije J. A. ^{[1
,2
,3
]}

Horsthuis, Karin ^{[4
]}

Beets-Tan, Regina G. H. ^{[5
,6
,7
,8
]}

Aalbers, Arend G. J. ^{[9
]}

Beets, Geerard L. ^{[6
,9
]}

Boerma, Evert-Jan G. ^{[10
]}

Borstlap, Jaap ^{[11
]}

Smallenburg, Vivian van Breest ^{[12
]}

Burger, Jacobus W. A. ^{[13
]}

Crolla, Rogier M. P. H. ^{[14
]}

Daniels-Gooszen, Alette W. ^{[15
]}

Davids, Paul H. P. ^{[16
]}

Dunker, Michalda S. ^{[17
]}

Fabry, Hans F. J. ^{[18
]}

Furnee, Edgar J. B. ^{[19
]}

van Gils, Renza A. H. ^{[20
]}

de Haas, Robbert J. ^{[21
]}

Hoogendoorn, Stefan ^{[22
]}

van Koeverden, Sebastiaan ^{[23
,42
]}

de Korte, Fleur, I ^{[24
]}

Oosterling, Steven J. ^{[25
]}

Peeters, Koen C. M. J. ^{[26
]}

Posma, Lisanne A. E. ^{[27
]}

Pultrum, Bareld B. ^{[28
]}

Rothbarth, Joost ^{[29
]}

Rutten, Harm J. T. ^{[6
,13
]}

Schasfoort, Renske A. ^{[30
]}

Schreurs, Wilhelmina H. ^{[17
]}

Simons, Petra C. G. ^{[31
]}

Smits, Anke B. ^{[32
]}

Talsma, Aaldert K. ^{[33
]}

The, G. Y. Mireille ^{[34
]}

van Tilborg, Fiek ^{[35
]}

Tuynman, Jurriaan B. ^{[1
,2
,3
]}

Vanhooymissen, Inge J. S. ^{[4
]}

van de Ven, Anthony W. H. ^{[36
]}

Verdaasdonk, Emiel G. G. ^{[37
]}

Vermaas, Maarten ^{[38
]}

Vliegen, Roy F. A. ^{[39
]}

Vogelaar, F. Jeroen ^{[40
]}

de Vries, Marianne ^{[20
]}

Vroemen, Joy C. ^{[41
]}

van Vugt, Sebastiaan T.

Westerterp, Marinke ^{[43
]}

van Westreenen, Henderik L. ^{[44
]}

de Witt, Johannes H. W. ^{[45
]}

van der Zaag, Edwin S. ^{[46
]}

Zimmerman, David D. E. ^{[47
]}

Marijnen, Corrie A. M. ^{[48
,49
]}

机构：

[1] Locat Vrije Univ Amsterdam, Amsterdam UMC, Dept Surg, Amsterdam, Netherlands

[2] Canc Ctr Amsterdam, Treatment & Qual Life, Amsterdam, Netherlands

[3] Canc Ctr Amsterdam, Imaging & Biomarkers, Amsterdam, Netherlands

[4] Vrije Univ Amsterdam, Amsterdam UMC Locat, Dept Radiol & Nucl Med, Amsterdam, Netherlands

[5] Netherlands Canc Inst, Dept Radiol, Amsterdam, Netherlands

[6] Univ Maastricht, GROW Sch Oncol & Reprod, Maastricht, Netherlands

[7] Odense Univ Hosp, Dept Radiol, Odense, Denmark

[8] Univ Southern Denmark, Dept Clin Res, Odense, Denmark

[9] Netherlands Canc Inst, Dept Surg, Amsterdam, Netherlands

[10] Zuyderland Med Ctr, Dept Surg, Geleen, Netherlands

[11] Treant Zorggroep, Dept Radiol, Hoogeveen, Netherlands

[12] Jeroen Bosch Hosp, Dept Radiol, Shertogenbosch, Netherlands

[13] Catharina Hosp, Dept Surg, Eindhoven, Netherlands

[14] Amphia Hosp, Dept Surg, Breda, Netherlands

[15] Catharina Hosp, Dept Radiol, Eindhoven, Netherlands

[16] Diakonessen Hosp, Dept Surg, Utrecht, Netherlands

[17] NWZ Alkmaar, Northwest Clin, Dept Surg, Alkmaar, Netherlands

[18] Bravis Hosp, Dept Surg, Roosendaal, Netherlands

[19] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Div Abdominal Surg, Groningen, Netherlands

[20] Erasmus MC, Dept Radiol, Rotterdam, Netherlands

[21] Univ Groningen, Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands

[22] Isala, Dept Radiol, Zwolle, Netherlands

[23] Radboud Univ Nijmegen, Med Ctr, Dept Radiol, Nijmegen, Netherlands

[24] Haaglanden Med Ctr, Dept Radiol, The Hague, Netherlands

[25] Spaarne Gasthuis, Dept Surg, Haarlem, Netherlands

[26] Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands

[27] Slingeland Hosp, Dept Surg, Doetinchem, Netherlands

[28] Martini Hosp, Dept Surg, Groningen, Netherlands

[29] Dept Surg Oncol & Gastrointestinal Surg, Rotterdam, Netherlands

[30] Treant Zorggroep, Dept Surg, Hoogeveen, Netherlands

[31] VieCuri Med Ctr, Dept Radiol, Venlo, Netherlands

[32] St Antonius Hosp, Dept Surg, Nieuwegein, Netherlands

[33] Deventer Hosp, Dept Surg, Deventer, Netherlands

[34] Bravis Hosp, Dept Radiol, Roosendaal, Netherlands

[35] Elisabeth TweeSteden Hosp, Dept Radiol, Tilburg, Netherlands

[36] Flevoziekenhuis, Dept Surg, Almere, Netherlands

[37] Jeroen Bosch Hosp, Dept Surg, Shertogenbosch, Netherlands

[38] IJsselland Hosp, Dept Surg, Capelle Aan Den Ijssel, Netherlands

[39] Zuyderland Med Ctr, Dept Radiol, Geleen, Netherlands

[40] VieCuri Med Ctr, Dept Surg, Venlo, Netherlands

[41] Flevoziekenhuis, Dept Radiol, Almere, Netherlands

[42] Wilhelmina Assen Hosp, Dept Surg, Assen, Netherlands

[43] Haaglanden Med Ctr, Dept Surg, The Hague, Netherlands

[44] Isala, Dept Surg, Zwolle, Netherlands

[45] Radboud Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands

[46] Gelre Hosp, Dept Surg, Apeldoorn, Netherlands

[47] Elisabeth TweeSteden Hosp, Dept Surg, Tilburg, Netherlands

[48] Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands

[49] Leiden Univ, Med Ctr, Dept Radiat Oncol, Leiden, Netherlands

[50] Univ Amsterdam, Amsterdam UMC Locat, Dept Surg, Amsterdam, Netherlands

来源：

ANNALS OF SURGICAL ONCOLOGY | 2023年 / 30卷 / 09期

关键词：

DISSECTION; MULTICENTER;

D O I：

10.1245/s10434-023-13460-0

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background. Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level.Methods. Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either 'node-picking' (the removal of an individual LLN) or 'partial regional node dissection' (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (=7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection.Results. Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7-3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2-2.5, p = 0.874).Conclusion. Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.

引用

页码：5472 / 5485

页数：14

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