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Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes

2021; Oxford University Press; Volume: 108; Issue: 2 Linguagem: Inglês

10.1093/bjs/znaa009

1365-2168

Dennis P. Schaap, Leonora S. F. Boogerd, Tsuyoshi Konishi, Chris Cunningham, Atsushi Ogura, Julio García‐Aguilar, Geerard L. Beets, Takayuki Suzuki, Shigeo Toda, In Kyu Lee, Tarik Sammour, Keisuke Uehara, P Lee, Jurriaan B. Tuynman, Cornelis J.�H. van de Velde, H.J.T. Rutten, Miranda Kusters, Miranda Kusters, Jurriaan B. Tuynman, Roel Hompes, Takashi Akiyoshi, Tsuyoshi Konishi, Grard A. P. Nieuwenhuijzen, H.J.T. Rutten, Dennis P. Schaap, Henrik Iversen, Anna Martling, Takayuki Suzuki, E. Meershoek-Klein-Kranenbarg, Atsushi Ogura, Hein Putter, Cornelis J.�H. van de Velde, Julio García‐Aguilar, Marc J. Gollub, Toshisada Aiba, Atsushi Ogura, Keisuke Uehara, Arend G. J. Aalbers, Geerard L. Beets, R.G.H. Beets-Tan, Monique Maas, M. Betts, Chris Cunningham, Hong Lee, James W. Moore, Tarik Sammour, Michelle Thomas, Tim Wells, P Lee, Michael J. Solomon, Min-Ho Choi, Minjun Kim, In Kyu Lee, Shiaki Oh, Dong-Il Won, Yutaka Hanaoka, Hiroya Kuroyanagi, Shigeo Toda, Kenji Tomizawa, H.J.T. Rutten, Kieran Brown, P Lee, Michael J. Solomon,

Colorectal Cancer Screening and Detection

Abstract Background In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Methods Patients with low cT3–4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. Results More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Conclusion Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes. Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.