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Clinical outcomes of selective lateral pelvic lymph node dissection with preoperative chemoradiotherapy for lower rectal cancer
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T. Matsuda1,
Y. Sumi1,
Y. Kakeji1 |
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1Department of Gastrointestinal Surgery, Kobe University Graduate School of Medicine |
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| Background The clinical significance of lateral pelvic lymph node dissection (LPLND) and preoperative chemoradiotherapy (CRT) for lower rectal cancer remains unclear. Methods A total of 45 patients with lower rectal cancer who underwent curative surgery after CRT from 2005 to 2016 were analyzed. Preoperative CRT consisted of 45 Gy radiation and UFT/LV. LPLND was performed only for the patients with swollen LPLNs (>8 mm in diameter) based on the pretreatment images.Results LPLND was performed in 30 (66.7%) patients. Although operative time was significantly longer in LPLND (+) group, there were no significant difference in blood loss and postoperative morbidity between LPLND (-) and (+) groups.5year OS and RFS were 85.7% and 61.8%, respectively. Only histological response was significantly associated with local recurrence by multivariate analyses. There were no local recurrences in good responders.In 30 patients with LPLND (+), 7 (23.3%) were proven pathologically positive LPLN metastasis. Among these 7 patients, 3 developed local recurrence. In 23 patients with pathologically negative LPLN metastasis, 3 developed local recurrence. No local recurrence developed in LPLND (-) group regardless of histological response.Conclusion For the patients with no swollen LPLNs, LPLND can be omitted when preoperative CRT is employed. Although selective LPLND with preoperative CRT seems valid in good responders, new treatment strategy needs to be established for poor responders. |
Index Term 1: CRT
Index Term 2: LPLND |
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