DOI: http://dx.doi.org/10.18203/2349-2902.isj20192150

Role of pelvic lymphadenectomy in rectal cancer

Ibrahim H. Aboelatta, Soliman A. El-Shakhs, Abd Elmieniem F. Mohammed, Mohammed H. Milegy

Abstract


Background: Rectal cancer constitutes about one third of all colorectal cancer cases. Total mesorectal excision has become the gold standard in rectal cancer treatment. However total mesorectal excision does not involve any approaches for lateral pelvic lymph nodes (LPLN), which may be asource of local recurrences. Tumor containing LPLN were reported to be found in about 10%-20% of the rectal cancer patients. In japan lateral pelvic lymph node metastasis is accepted to be curable with excision.

Methods: This study included 20 patients presented to Menofia Hospital for elective colorectal re sections and LPLN dissection, in the period from July 2016 to January 2019.

Results: This study on 13 male (65%), 7 female (35%), all patients included in the study underwent preoperative chemoradiation according to the technique described by Marks et al. with an overall administration of 45 cGy over 5 weeks. Dissection of 180 lymph nodes was retrieved (20%) lymph nodes pathologically were positive for malignancy.

Conclusions: Lateral pelvic lymph nodes dissection is an important in rectal cancer treatment.


Keywords


Rectal cancer, Lateral pelvic lymph node, Metastasis, Neoadjuvant chemoradiotherapy

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References


Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 2006;1:1479–82.

Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2004;235:449–57.

Jass JR, Baker M, Fraser L et al. APC mutation and tumour budding in colorectal cancer. J Clin Pathol. 2007;56:69–73.

Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Col Surg. 2005;181:305–46.

Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum. 2009;32:307–15.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2011;345:638–46.

Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet. 2013;358:1291–304.

Komuta K, Okudaira S, Haraguchi M, Furui J, Kanematsu T. Identification of extracapsular invasion of the metastatic lymph nodes as a useful prognostic sign in patients with resectable colorectal cancer. Dis Colon Rectum. 2011;44:1838–44.

Murphy J, Pocard M, O’Sullivan G et al. Causes and prognostic significance of variable lymph node retrieval in Dukes’ B rectal carcinoma. Gut. 2009;44:84.

Brynes RK, Hunter RL, Vellios F. Immunomorphological changes in regional lymph nodes associated with cancer. Arch Path Lab Med. 2013;107:217.

Pihl E, Nairn R, Milne BJ. Lymphoid hyperplasia: a major prognostic feature in 519 cases of colorectal carcinoma. Am J Pathol. 2010;100:469.

Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2009;15:729-73

Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.

Matsumoto T, Ohue M, Sekimoto M, Yamamoto H, Ikeda M, Monden M. Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases. Br J Surg. 2005;92:1444-8.

Brenner H, Hoffmeister M, Arndt M, Haug U. Gender differences in colorectal cancer:implications for age at initiation of screening. Br J Cancer. 2007;96:828–31.

Pox CP, Altenhofen L, Brenner H, Theilmeier A, Theilmeier A, Von Stillfried D, Schmiegel W. Efficacy of a Nationwide Screening Colonoscopy Program for Colorectal Cancer. Gastroenterology. 2012;14(7):1460-7.

Tamura H, Shimada Y, Kameyama H, Yagi R, Tajima Y, Okamura T, et al. Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer. World J Clin Oncol. 2017;8(5):412-9.

Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 2014;21:189-96.

Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52:567-76.

Yano H, Moran BJ. The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg. 2008;95:33-49.

Mercury Study Group, Shihab OC, Taylor F, Bees N, Blake H, Jeyadevan N, et al. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98:1798-804.

Sueda T, Noura S, Ohue M, Shingai T, Imada S, et al. Case of isolated lateral lymph node recurrence occurring after TME for T1 lower rectal cancer treated with lateral lymph node dissection: report of a case. Surg Today 2013;43:809-13.

Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13:616-21.

Dharmarajan S, Shuai D, Fajardo AD, Birnbaum EH, Hunt SR, Mutch MG, et al. Clinically enlarged lateral pelvic lymph nodes do not influence prognosis after neoadjuvant therapy and TME in stage III rectal cancer. J Gastrointest Surg. 2011;15(8):1368-74.

Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer:a meta-analysis. Lancet. 2009;10(11):1053-62.