Lateral lymph node dissection has been 1 of the standard treatments for mid and ow rectal cancer in Japan. The aim of this ad-hoc analysis was to evaluate the impact of lateral lymph node dissection on outcomes in the randomized clinical trial, referred to as the Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial.
The Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial was a randomized, phase III trial of adjuvant chemotherapy of 2 different oral fluoropyrimidines; 445 patients with lower rectal cancer were studied in this ad-hoc analysis out of 959 patients in total, 215 of whom underwent lateral lymph node dissection and 230 did not.
There were no significant differences in background characteristics of the patients in the group, except for in age and number of dissected lymph nodes, between the lateral lymph node dissection and without lateral lymph node dissection groups. The age of the younger patients was often used to select candidates for lateral lymph node dissection (lateral lymph node dissection versus non–lateral lymph node dissection; 63.5 ± 8.9 vs 60.7 ± 9.4 [P = .0017]). Lateral lymph node dissection had no impact on relapse-free survival (hazard ratio = 0.941, 95% confidence interval: 0.696–1.271) or overall survival (hazard ratio = 0.858, 95% confidence interval: 0.601–1.224) in all patients with mid and low rectal cancer. In subset analysis, lateral lymph node dissection improved relapse-free survival in female patients and in patients with stage B/C or N3/4 disease. For cumulative recurrence across all patients, the proportion of patients with distant recurrence was slightly greater in the lateral lymph node dissection group but there was no difference in local recurrence.
This exploratory analysis did not show that lateral lymph node dissection improves relapse-free survival and overall survival in patients with mid and low rectal cancer. Lateral lymph node dissection may, however, have a prognostic impact on patients with highly invasive rectal cancer.
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- Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.Int J Cancer. 2015; 136: E359-E386
- A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol. 2017; 2: 501-513
- Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial.The Lancet Oncology. 2011; 12: 575-582
- The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?.The British Journal of Surgery. 1982; 69: 613-616
- Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975–2004.Anticancer Research. 2013; 33: 2921-2927
- Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial.Annals of Surgery. 2017; 266: 201-207
- Lateral pelvic lymph-node dissection: still an option for cure.The Lancet Oncology. 2010; 11: 114
- Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease.Annals of Surgery. 2012; 255: 1129-1134
- Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging.Annals of surgical oncology. 2014; 21: 189-196
- Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis.Lancet Oncol. 2009; 10: 1053-1062
- A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC).Ann Oncol. 2016; 27: 1266-1272
- Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer.Int J Clin Oncol. 2018; 23: 1-34
- Benefit of lateral lymph node dissection for rectal cancer: long-term analysis of 944 cases undergoing surgery at a single center (1975–2004).Anticancer Research. 2014; 34: 4633-4639
- Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND.Surgery. 2017; 162: 303-314
- Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis.Annals of Surgical Oncology. 2009; 16: 3271-3278
- Impact of lateral pelvic lymph node dissection on the survival of patients with T3 and T4 low rectal cancer.World Journal of Surgery. 2016; 40: 1492-1499
- Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease?.Ann Surg. 2012; 255: 1129-1134
- Prognostic factors of rectal cancer patients with lateral pelvic lymph node metastasis.Hepato-gastroenterology. 2012; 59: 2494-2497
Published online: October 09, 2018
Accepted: August 28, 2018
Received in revised form: August 14, 2018
Received: June 19, 2018
© 2018 Elsevier Inc. All rights reserved.