|Table of Contents|

The efficacy of total mesorectal excision combined with lateral lymph node dissection in the treatment of lateral lymph node metastasis in middle and low rectal cancer

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 24
Page:
4576-4581
Research Field:
Publishing date:

Info

Title:
The efficacy of total mesorectal excision combined with lateral lymph node dissection in the treatment of lateral lymph node metastasis in middle and low rectal cancer
Author(s):
HAN Xiaodong1; 2; LI Kan1; WU Yachao1; JIANG Yujuan2; LIU Chunming2; HUANG Tianchen1
1.Department of General Surgery,Anyang Cancer Hospital,Henan Anyang 455000,China;2.Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Me
Keywords:
rectal cancer; lateral lymph node; lateral lymph node dissection; prognosis
PACS:
R735.3+7
DOI:
10.3969/j.issn.1672-4992.2023.24.017
Abstract:
Objective:To evaluate the efficacy of lateral lymph node dissection(LLND) for rectal cancer patients with LLN metastasis and investigate the impact of LLN metastasis on prognosis.Methods:From January 2015 to January 2020,the data of middle-low rectal cancer patients with clinical evidence of LLN metastasis who underwent total mesorectal excision (TME)+LLND and rectal cancer patients who underwent radical resection of TME at the same time were retrospectively collected and analyzed.According to the surgical method,all patients were divided into TME+LLND group (n=129) and TME group (n=362).125 matched pairs were selected and divided into the TME group and TME+LLND group for evaluation after propensity matching.Long-term endpoint of this study was 3-year local recurrence rate (LR) and 3-year recurrence-free survival (RFS).Results:The operation time was significantly longer in the TME+LLND group than in the TME group (356.1 vs 244.8 min,P＜0.001),and there was no significant increase in postoperative complications (16.0 vs 12.0,P=0.362).No significant difference was observed in the 3-year LR rate between the TME group and the TME+LLND group (10.7% vs 8.8%,P=0.817),however,the rate of distant metastasis after TME+LLND was significantly higher (15.2% vs 7.2%,P=0.044).Subgroup analysis was performed according to lymph node status and stage,3-year RFS in patients with internal iliac and obturator metastases was similar to those in patients with N2 stage (57.1% vs 55.3%,P=0.613).3-year RFS of patients with external iliac and common iliac metastasis was similar to those of patients with stage IV (49.1% vs 22.5%,P=0.302) and significantly worse than those with N2 stage (49.1% vs 55.3%,P=0.044).Conclusion:Patients with LLN metastasis can achieve satisfactory local control after LLND.Patients limited to internal iliac and obturator lymph node metastasis appear to achieve a survival benefit from LLND and can be regarded as regional lymph node metastasis.Patients with external and common iliac lymph node metastasis have a poor prognosis that is significantly worse than that of N2 stage and slightly better than that of stage IV,and LLND should be carefully selected.

References:

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Memo

Memo:
中国癌症基金会北京希望马拉松专项基金（编号：LC2017A19）;国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(编号：2019YFC1315705)
Last Update: 1900-01-01