Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer

doi:10.5306/wjco.v8.i5.412

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 8, Issue 5

This Article

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (11797)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-3) series, Tables (1-3) series.

Item

Count

PDF

580

WORD

250

HTML

3975

Figures (1-3)

519

Tables (1-3)

465

Sum=5789

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

1097

Download

2228

Sum=3325

Publishing Process of This Article

Item

Count

Browse

755

Download

1927

Sum=2682

Oct 10, 2017 (publication date) through Mar 5, 2026

Times Cited of This Article

Times Cited (12)

Journal Information of This Article

Publication Name

World Journal of Clinical Oncology

ISSN

2218-4333

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

- Full Article with Cover (PDF)
- Full Article (XML)

Observational Study

World J Clin Oncol. Oct 10, 2017; 8(5): 412-419
Published online Oct 10, 2017. doi: 10.5306/wjco.v8.i5.412

Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer

Hiroshi Tamura, Yoshifumi Shimada, Hitoshi Kameyama, Ryoma Yagi, Yosuke Tajima, Takuma Okamura, Mae Nakano, Masato Nakano, Masayuki Nagahashi, Jun Sakata, Takashi Kobayashi, Shin-ichi Kosugi, Hitoshi Nogami, Satoshi Maruyama, Yasumasa Takii, Toshifumi Wakai

Hiroshi Tamura, Yoshifumi Shimada, Hitoshi Kameyama, Ryoma Yagi, Yosuke Tajima, Takuma Okamura, Mae Nakano, Masato Nakano, Masayuki Nagahashi, Jun Sakata, Takashi Kobayashi, Toshifumi Wakai, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan

Shin-ichi Kosugi, Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma 949-7302, Japan

Hitoshi Nogami, Satoshi Maruyama, Yasumasa Takii, Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8586, Japan

Author contributions: Tamura H and Shimada Y designed the report; Kameyama H, Tajima Y, Okamura T, Nakano M, Nakano M, Nagahashi M, Sakata J, Kobayashi T, Kosugi S, Nogami H, Maruyama S and Takii Y were attending doctors for the patients and performed surgical operation; Tamura H and Yagi R collected the patient’s clinical data; Tamura H and Shimada Y analyzed the data and wrote the paper; Wakai T approved the final version of the manuscript.

Institutional review board statement: This study was performed in accordance with the Helsinki Declaration, and the Ethics Committee of the School of Medicine. Niigata University approved the study protocol (approval number: 2330).

Informed consent statement: Niigata University approved the study protocol (approval number: 2330), waiving patient consent.

Conflict-of-interest statement: This study has no commercial interest, financial, or material support.

Data sharing statement: No additional data are available.

Correspondence to: Yoshifumi Shimada, MD, PhD, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan. shimaday@med.niigata-u.ac.jp

Telephone: +81-25-2272228 Fax: +81-25-2270779

Received: March 23, 2017
Peer-review started: March 24, 2017
First decision: May 10, 2017
Revised: May 27, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: October 10, 2017
Processing time: 186 Days and 16.1 Hours

Abstract

AIM

To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer.

METHODS

We selected 71 consecutive stage IV low rectal cancer patients who underwent primary tumor resection, and enrolled 50 of these 71 patients without clinical LPLN metastasis. The patients had distant metastasis such as liver, lung, peritoneum, and paraaortic LN. Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan. All patients underwent primary tumor resection, 27 patients underwent total mesorectal excision (TME) with LPLND (LPLND group), and 23 patients underwent only TME (TME group). Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group. R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients. We evaluated possible prognostic factors for 5-year overall survival (OS), and compared 5-year cumulative local recurrence between the LPLND and TME groups.

RESULTS

For OS, univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%, P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor. Regarding cumulative local recurrence, the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%, P = 0.833).

CONCLUSION

Prophylactic LPLND shows no oncological benefits in patients with Stage IV low rectal cancer without clinical LPLN metastasis.

Keywords: Prophylactic lateral pelvic lymph node dissection; Stage IV; Low rectal cancer

Core tip: The clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer has not been proven. In this study, we showed two main findings concerning treatment strategy in these patients. First, prophylactic LPLND was not a significant prognostic factor for overall survival and did not contribute local control. Second, R0 resection was an independent prognostic factor for overall survival. These results suggest that prophylactic LPLND is not an important component of surgical treatment in stage IV low rectal cancer patients.