What is the impact of systemic chemotherapy for lateral lymph nodes in patients with locally advanced low rectal cancer?
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ORIGINAL ARTICLE
What is the impact of systemic chemotherapy for lateral lymph nodes in patients with locally advanced low rectal cancer? Atsushi Ogura 1 & Kay Uehara 1 & Toshisada Aiba 1 & Norifumi Hattori 2 & Goro Nakayama 2 & Osamu Maeda 3 & Yuichi Ando 3 & Yasuhiro Kodera 2 & Tomoki Ebata 1 & Masato Nagino 1 Accepted: 6 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Systemic chemotherapy (SC) before surgery is a potential treatment to improve survival in patients with advanced rectal cancer. However, the impact of SC on lateral lymph nodes (LLNs) remains unclear. Methods A total of 78 patients with stage II/III low rectal cancer, who received 3-month oxaliplatin-based SC followed by LLN dissection (LLND) in principle, were analysed retrospectively. “Total lateral lymph node metastases (tLLNMs)” was defined as having either pathological LLNMs (pLLNMs) or lateral local recurrences (LLRs). Patients with the maximum short-axis size of LLNs ≥ 7 mm were classified into the swollen group (n = 21). Results In the total cohort, tLLNMs included 6 pLLNMs (7.7%) and 2 LLRs (2.6%). In the non-swollen group, no patients had pLLNMs, but one had LLR (1.8%). In the swollen group, pLLNMs and LLRs were detected in 6 (28.6%) and 1 (4.8%), respectively. The swollen group was an independent risk factor for tLLNMs (P < 0.001), leading to the significantly worse 5year relapse-free survival (RFS) of 52.4% than the others. Conclusion For patients without swollen LLNs, SC could allow for omission both of lateral irradiation and LLND. For patients with swollen LLNs, the lateral local control was favourable after SC and LLND without chemoradiotherapy (CRT); however, oxaliplatin-based SC might be insufficient to improve survival, requiring more intensive chemotherapy. CRT should be indicated according to the other risk factors of central local recurrence, although the swollen LLNs should be removed. Keywords Rectal cancer . Systemic chemotherapy . Lateral lymph node . Lateral lymph node metastasis
Introduction The standard treatment for advanced rectal cancer has been neoadjuvant chemoradiotherapy (CRT) + total mesorectal excision (TME) in Western countries [1–3]. For low-risk patients, the omission of CRT has recently spread mainly in European countries [4], and some recent reports concerning lateral local recurrences (LLRs) after CRT + TME [5, 6]
* Kay Uehara [email protected] 1
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
2
Division of Gastrointestinal Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
3
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
highlight a need to determine how to select patients who truly need lateral lymph node dissection (LLND), which has been the standard treatment for stage II/III low rectal cancer in Japan. Similar to the risk-adapted treatment in European countries, the omission of LLND
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