Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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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Article info
Publication history
Published online: October 09, 2018
Accepted:
August 28,
2018
Received in revised form:
August 14,
2018
Received:
June 19,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
