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Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

2023; Springer Science+Business Media; Volume: 30; Issue: 9 Linguagem: Inglês

10.1245/s10434-023-13460-0

1534-4681

Tania C. Sluckin, Sanne-Marije J.A. Hazen, Karin Horsthuis, Regina G. H. Beets‐Tan, Arend G. J. Aalbers, Geerard L. Beets, Evert-Jan G. Boerma, Jaap Borstlap, Vivian van Breest Smallenburg, Jacobus W. A. Burger, Rogier M. P. H. Crolla, Alette W. Daniëls-Gooszen, P. H. P. Davids, Michalda S. Dunker, Hans F. J. Fabry, Edgar J.B. Furnée, Renza A. H. van Gils, Robbert J. de Haas, Stefan Hoogendoorn, Sebastiaan van Koeverden, Fleur I. de Korte, Steven J. Oosterling, Koen Peeters, Lisanne A. E. Posma, Bareld B. Pultrum, Joost Rothbarth, H.J.T. Rutten, Renske A. Schasfoort, Wilhelmina H. Schreurs, Petra C. G. Simons, Anke B. Smits, Aaldert K. Talsma, G. Y. Mireille The, Fiek van Tilborg, Jurriaan B. Tuynman, Inge J. S. Vanhooymissen, Anthony W. H. van de Ven, Emiel G. G. Verdaasdonk, Maarten Vermaas, Roy F. A. Vliegen, F. Jeroen Vogelaar, Marianne de Vries, Joy C. Vroemen, Sebastiaan T. van Vugt, Marinke Westerterp, Henderik L. van Westreenen, Johannes H. W. de Wilt, Edwin S. van der Zaag, D. D. E. Zimmerman, Corrie A.M. Marijnen, Pieter J. Tanis, Miranda Kusters, Susanna M. van Aalten, Femke J. Amelung, Marjolein Ankersmit, Imogeen E. Antonisse, J. F. Ashruf, Tjeerd S. Aukema, Henk Avenarius, Renu R. Bahadoer, Frans C. H. Bakers, Ilsalien S. Bakker, Fleur Bangert, Renée M. Barendse, Heleen M. D. Beekhuis, Willem A. Bemelman, Maaike Berbée, Shira H. de Bie, Robert H. C. Bisschops, Robin D. Blok, Liselotte W. van Bockel, Anniek H. Boer, Frank C. den Boer, Leonora S. F. Boogerd, Wernard A. A. Borstlap, Johanna E. Bouwman, Sicco J. Braak, Manon N.G.J.A. Braat, Jennifer Bradshaw, Amarins T. A. Brandsma, W.T. van den Broek, Sjirk W. van der Burg, Thijs A. Burghgraef, David W.G. ten Cate, Heleen M. Ceha, Jeltsje S. Cnossen, Robert R.J. Coebergh van den Braak, Esther C. J. Consten, Maaike Corver, Sam Curutchet, Emmelie N. Dekker, Jan Willem T. Dekker, Ahmet Demirkıran, Tyche Derksen, Arjen L. Diederik, Anne M. Dinaux, Kemal Doğan, Ilse M. van Dop, Kitty E. Droogh-de Greve, Hanneke M. H. Duijsens, Johan Duyck, Eino B. van Duyn, Laurentine S. E. van Egdom, Bram Eijlers, Youssef El-Massoudi, Saskia van Elderen, Anouk M. L. H. Emmen, Marc R. Engelbrecht, Anne C. van Erp, Jeroen A. van Essen, Thomas Fassaert, Eline A. Feitsma, Shirin S. Feshtali, Bas Frietman, Anne M. van Geel, Elisabeth D. Geijsen, Anna A. W. van Geloven, Michael F. Gerhards, H. A. J. Gielkens, Lucas Goense, Marc J. P. M. Govaert, Wilhelmina M. U. van Grevenstein, E. Joline de Groof, Irene de Groot, Nadia A. G. Hakkenbrak, Mariska D.den Hartogh, Vera Heesink, Joost T. Heikens, Ellen M. Hendriksen, Sjoerd van den Hoek, E.J. Hoeven, Christiaan Hoff, Anna Hogewoning, Cornelis R. C. Hogewoning, Roel Hompes, François van Hoorn, René L. van der Hul, Rieke van Hulst, Farshad Imani, Bas Inberg, Martijn Intven, Pedro Janssen, Chris E. J. de Jong, Jacoline Jonkers, Daniela Jou-Valencia, Bas Keizers, Stijn H. J. Ketelaers, Eva Knöps, Sylvia Kok, Stephanie E. M. Kolderman, R.T.J. Kortekaas, Julie C. Korving, Ingrid Köster, Jasenko Krdzalic, Pepijn Krielen, Leonard F. Kroese, Eveline J. T. Krul, Derk H. H. Lahuis, Bas Lamme, An A. G. van Landeghem, Jeroen W. A. Leijtens, Mathilde M. Leseman-Hoogenboom, Manou S. de Lijster, Martijn S. Marsman, Milou H. Martens, Ilse Masselink, Wout van der Meij, Philip Meijnen, Jarno Melenhorst, Dietrich J. L. de Mey, Julia Moelker-Galuzina, Linda Morsink, Erik J. Mulder, K. Müller, Gijsbert D. Musters, Joost Nederend, Peter A. Neijenhuis, Lindsey C. F. de Nes, M. Nielen, Jan B. J. van den Nieuwboer, Jonanne F. Nieuwenhuis, Joost Nonner, Bo Jan Noordman, Stefi Nordkamp, Pim B. Olthof, Daan Ootes, Vera Oppedijk, Pieter Ott, Ida Paulusma, Ilona T. A. Pereboom, Jan Peringa, Zoë Pironet, Joost D. J. Plate, Fatih Polat, Ingrid G. M. Poodt, Jeroen F. Prette, Seyed M. Qaderi, Jan M. van Rees, Rutger-Jan Renger, Anouk J. M. Rombouts, Lodewijk J. Roosen, Ellen A. Roskott-ten Brinke, Dennis B. Rouw, Tom Rozema, Heidi Rütten, Marit E. van der Sande, Boudewijn E. Schaafsma, Merel M. Scheurkogel, Arjan P. Schouten van der Velden, Puck M. E. Schuivens, Colin Sietses, Marjan J. Slob, Gerrit D. Slooter, Martsje van der Sluis, Bo P. Smalbroek, Ernst J. Spillenaar-Bilgen, Patty H. Spruit, Tanja C. Stam, Sofieke Temmink, Jeroen A. W. Tielbeek, Aukje A. J. M. van Tilborg, Dorothée van Trier, Maxime J.M. van der Valk, G. Boudewijn C. Vasbinder, Cornelis J. Veeken, Laura A. Velema, Wouter M. Verduin, Tim Verhagen, Paul M. Verheijen, An-Sofie Verrijssen, Anna V. D. Verschuur, Harmke Verwoerd-van Schaik, Sophie Voets, Clementine L. A. Vogelij, Johanna Vos-Westerman, Johannes A. Wegdam, Bob J. van Wely, Paul P. van Westerveld, Allard G. Wijma, Bart W. K. de Wit, Fennie Wit, Karlijn Woensdregt, Victor van Woerden, Floor S. W. van der Wolf, Sander van der Wolk, Johannes M. Wybenga, Bobby Zamaray, Herman J.A. Zandvoort, Dennis van der Zee, Annette Zeilstra, Kang J. Zheng, Marcel Zorgdrager,

Colorectal Cancer Screening and Detection

Abstract Background Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either ‘node-picking’ (the removal of an individual LLN) or ‘partial regional node dissection’ (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. Results Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking ( n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND ( n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery ( n = 48) or rectal resection alone ( n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.