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Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study

Agger, E. LU orcid ; Åkerlund, V. ; Ekberg, O. LU ; Jörgren, F. LU ; Lydrup, M. L. LU and Buchwald, P. LU (2021) In International Journal of Colorectal Disease 36(12). p.2707-2714
Abstract

Purpose: Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). Methods: Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. Results: One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3–T4 ≤ 10 cm from the anal verge were... (More)

Purpose: Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). Methods: Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. Results: One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3–T4 ≤ 10 cm from the anal verge were analysed. Thirty (8.7%) patients with MRI-positive LLN were identified. Synchronous distant metastases were associated with MRI-positive LLN (p-value 0.019). Long-course chemoradiotherapy was clinical practice in cases of MRI-positive LLN. No differences in local (p-value 0.154) or distant (p-value 0.343) recurrence rates between MRI-positive LLN patients and MRI-negative patients were detected. Only four patients underwent lateral lymph node dissection (LLND). There was no significant difference in overall survival during follow-up between the MRI-negative (CI at 95%; 99–109 months) and MRI-positive group (CI at 95%; 69–108 months; p-value 0.14). Conclusion: Lateral lymph node metastases present a challenging clinical situation. The present study shows that combination of neoadjuvant therapy and selective LLND is an applicable strategy in cases of MRI-positive LLN.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chemoradiotherapy, Lateral lymph node metastases, Rectal cancer
in
International Journal of Colorectal Disease
volume
36
issue
12
pages
2707 - 2714
publisher
Springer
external identifiers
  • pmid:34487231
  • scopus:85114366980
ISSN
0179-1958
DOI
10.1007/s00384-021-04018-1
language
English
LU publication?
yes
id
150d7acb-c875-475c-ade5-c75c14975a3f
date added to LUP
2021-09-30 15:00:48
date last changed
2024-04-20 12:11:54
@article{150d7acb-c875-475c-ade5-c75c14975a3f,
  abstract     = {{<p>Purpose: Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). Methods: Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. Results: One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3–T4 ≤ 10 cm from the anal verge were analysed. Thirty (8.7%) patients with MRI-positive LLN were identified. Synchronous distant metastases were associated with MRI-positive LLN (p-value 0.019). Long-course chemoradiotherapy was clinical practice in cases of MRI-positive LLN. No differences in local (p-value 0.154) or distant (p-value 0.343) recurrence rates between MRI-positive LLN patients and MRI-negative patients were detected. Only four patients underwent lateral lymph node dissection (LLND). There was no significant difference in overall survival during follow-up between the MRI-negative (CI at 95%; 99–109 months) and MRI-positive group (CI at 95%; 69–108 months; p-value 0.14). Conclusion: Lateral lymph node metastases present a challenging clinical situation. The present study shows that combination of neoadjuvant therapy and selective LLND is an applicable strategy in cases of MRI-positive LLN.</p>}},
  author       = {{Agger, E. and Åkerlund, V. and Ekberg, O. and Jörgren, F. and Lydrup, M. L. and Buchwald, P.}},
  issn         = {{0179-1958}},
  keywords     = {{Chemoradiotherapy; Lateral lymph node metastases; Rectal cancer}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{2707--2714}},
  publisher    = {{Springer}},
  series       = {{International Journal of Colorectal Disease}},
  title        = {{Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study}},
  url          = {{http://dx.doi.org/10.1007/s00384-021-04018-1}},
  doi          = {{10.1007/s00384-021-04018-1}},
  volume       = {{36}},
  year         = {{2021}},
}