Chen JN, Liu Z, Wang ZJ, Mei SW, Shen HY, Li J, Pei W, Wang Z, Wang XS, Yu J, Liu Q. Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer. World J Gastroenterol 2020; 26(21): 2877-2888 [PMID: 32550762 DOI: 10.3748/wjg.v26.i21.2877]
Corresponding Author of This Article
Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
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Chen JN, Liu Z, Wang ZJ, Mei SW, Shen HY, Li J, Pei W, Wang Z, Wang XS, Yu J, Liu Q. Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer. World J Gastroenterol 2020; 26(21): 2877-2888 [PMID: 32550762 DOI: 10.3748/wjg.v26.i21.2877]
World J Gastroenterol. Jun 7, 2020; 26(21): 2877-2888 Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2877
Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Xi-Shan Wang, Jun Yu, Qian Liu
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Xi-Shan Wang, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
Jun Yu, Departments of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
Author contributions: Chen JN and Wang ZJ designed the research; Mei SW, Shen HY, and Li J collected the data; Pei W, Wang Z, and Liu Z analyzed the data; Chen JN drafted the article; Liu Q, Yu J, and Wang XS revised the paper.
Supported bythe Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006; and China Scholarship Council, No. CSC201906210471.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All patients signed informed consent forms.
Conflict-of-interest statement: The authors declare there is no conflict of interest in regard to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have carefully read the STROBE statement checklist of items and prepared the manuscript based on the requirements of the STROBE statement checklist of items.
Corresponding author: Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Received: January 7, 2020 Peer-review started: January 7, 2020 First decision: February 19, 2020 Revised: April 17, 2020 Accepted: April 28, 2020 Article in press: April 28, 2020 Published online: June 7, 2020 Processing time: 151 Days and 10.9 Hours
ARTICLE HIGHLIGHTS
Research background
Lateral lymph node metastasis is one of the leading causes for local recurrence in patients with advanced mid or low rectal cancer. The addition of lateral lymph node dissection (LLND) after neoadjuvant chemoradiotherapy (NCRT) remains a controversial topic.
Research motivation
There is a lack of consensus leading to an East (mainly Japan)-West division concerning the management of lateral lymph nodes after NCRT associated with lower rectal cancer. There are few data regarding surgical outcomes of total mesorectal excision (TME) plus LLND after NCRT.
Research objectives
The main aim of this study was to investigate the surgical outcomes of TME plus LLND, and the possible risk factors for lateral lymph node metastasis after NCRT.
Research methods
We performed an observational study and enrolled patients who underwent TME plus LLND. Information regarding the clinicopathologic features and clinical outcomes was collected and analyzed. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in the NCRT patients.
Research results
Lateral lymph node metastasis can be found in lower rectal cancer patients with enlarged lymph node size. Advanced T stage, poor differentiation type, and short axis ≥ 7 mm were statistically significant risk factors associated with LLN metastasis.
Research conclusions
Preoperative chemoradiotherapy is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater lateral lymph node short axis diameter, poorer histological differentiation or advanced T stage. Selective LLND for NCRT patients can have a favorable oncological outcome.
Research perspectives
Larger prospective multicenter clinal studies need to be performed so that standard managements regarding lateral lymph nodes in rectal cancer can be established.
