Int J Colorectal Dis (2014) 29:1077–1080 DOI 10.1007/s00384-014-1940-9
ORIGINAL ARTICLE
Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis Shin Fujita
Accepted: 22 June 2014 / Published online: 29 June 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Patients with lower rectal cancer occasionally have limited extramesorectal lymph node metastasis. However, the incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis remain unclear. Methods A total of 714 patients with clinical stage II or III lower rectal cancer who underwent extramesorectal lymph node dissection at the National Cancer Center Hospital between 1985 and 2011 were reviewed. Results Among the 714 patients with lower rectal cancer, 35 (4.9 %) had limited extramesorectal lymph node metastasis, of whom 28 (80.0 %) had one or two extramesorectal lymph node metastases. The 5-year overall survival rate was 74.5 %. The number of extramesorectal lymph node metastases was a significant prognostic factor. The 5-year overall survival rate of patients with three or more extramesorectal lymph node metastases was 28.6 %. Conclusions The incidence of limited extramesorectal lymph node metastasis in patients with lower rectal cancer was 4.9 %. Although the prognosis of patients with one or two extramesorectal lymph node metastases was favorable, that of patients with three or more such metastases was unfavorable.
Keywords Extramesorectal lymph node . Rectal cancer . Prognosis . Incidence
Introduction Total mesorectal excision (TME) is the standard surgery for rectal cancer. Although all of the lymph nodes in the mesorectum are resected by TME, lymph nodes outside the mesorectum (extramesorectal lymph nodes) are not. Extramesorectal lymph nodes in the pelvis and groin include the common iliac, internal iliac, external iliac, obturator, lateral sacral, presacral, sacral promontory, and inguinal lymph nodes. When lymph node metastasis is suspected upon preoperative or intraoperative examination, no consensus regarding lymph node dissection has yet been established. Among the extramesorectal lymph nodes, the internal iliac, obturator, common iliac, and external iliac lymph nodes are collectively referred to as the lateral pelvic lymph nodes [1]. At major hospitals in Japan, dissection of the lateral pelvic lymph nodes is indicated for patients with clinical stage II or III lower rectal cancer [2]. Moreover, dissection of other extramesorectal lymph nodes is also indicated for those with lymph node enlargement detected by preoperative or intraoperative examination. Among them, there are occasionally patients in whom mesorectal lymph node metastasis is absent and extramesorectal lymph node metastasis is present. Although the incidence and prognosis of rectal cancer patients with lateral pelvic lymph node metastasis have been reported [1, 3], those of rectal cancer patients with limited extramesorectal lymph node metastasis remain unclear. In the present study, therefore, I investigated this issue.
S. Fujita Colorectal Surgery Division, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan
Methods
S. Fujita (*) Department of Surgery, Tochigi Cancer Center, 9-13 Yonan 4-chome, Utsunomiya, Tochigi 320-0834, Japan e-mail: [email protected]
A total of 714 patients with clinical stage II or III lower rectal cancer who underwent extramesorectal lymph node dissection including lateral lymph node dissection at the National Cancer Center Hospital, Tokyo, between 1985 and 2011 were
1078
reviewed. In this study, extramesorectal lymph nodes were defined as lymph nodes in the pelvis and groin, which include the common iliac, internal iliac, external iliac, obturator, lateral sacral, presacral, sacral promontory, and inguinal lymph nodes. Lateral lymph node dissection is indicated for patients with clinical stage II or III rectal cancer where the lower margin is located at or below the peritoneal reflection [1]. Dissection of the other extramesorectal lymph nodes was performed for patients in whom lymph node enlargement was detected by preoperative or intraoperative examination. Among the 714 patients, 129 had pathologically confirmed extramesorectal lymph node metastasis. Among the 129 patients, 94 had mesorectal and extramesorectal lymph node metastasis and 35 had limited extramesorectal lymph node metastasis. Patients were followed up at three monthly intervals for 2 years, and at six monthly intervals thereafter. Tumor markers were examined at every patient visit. CT of the liver and lung or abdominal ultrasonography with chest X-ray was performed at least once every 6 months. Colonoscopy was performed twice within 5 years after surgery. The median follow-up time for the 35 patients was 5.8 years, and among them, 11 received adjuvant therapy (chemotherapy 5, chemoradiotherapy 3, radiotherapy 3). Statistical analysis Survival rates were calculated by the Kaplan-Meier method and differences were compared statistically by the log-rank test. Cox’s proportional hazards model was used for multivariate analysis. Data differences between groups were considered statistically significant at P
ORIGINAL ARTICLE
Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis Shin Fujita
Accepted: 22 June 2014 / Published online: 29 June 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Patients with lower rectal cancer occasionally have limited extramesorectal lymph node metastasis. However, the incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis remain unclear. Methods A total of 714 patients with clinical stage II or III lower rectal cancer who underwent extramesorectal lymph node dissection at the National Cancer Center Hospital between 1985 and 2011 were reviewed. Results Among the 714 patients with lower rectal cancer, 35 (4.9 %) had limited extramesorectal lymph node metastasis, of whom 28 (80.0 %) had one or two extramesorectal lymph node metastases. The 5-year overall survival rate was 74.5 %. The number of extramesorectal lymph node metastases was a significant prognostic factor. The 5-year overall survival rate of patients with three or more extramesorectal lymph node metastases was 28.6 %. Conclusions The incidence of limited extramesorectal lymph node metastasis in patients with lower rectal cancer was 4.9 %. Although the prognosis of patients with one or two extramesorectal lymph node metastases was favorable, that of patients with three or more such metastases was unfavorable.
Keywords Extramesorectal lymph node . Rectal cancer . Prognosis . Incidence
Introduction Total mesorectal excision (TME) is the standard surgery for rectal cancer. Although all of the lymph nodes in the mesorectum are resected by TME, lymph nodes outside the mesorectum (extramesorectal lymph nodes) are not. Extramesorectal lymph nodes in the pelvis and groin include the common iliac, internal iliac, external iliac, obturator, lateral sacral, presacral, sacral promontory, and inguinal lymph nodes. When lymph node metastasis is suspected upon preoperative or intraoperative examination, no consensus regarding lymph node dissection has yet been established. Among the extramesorectal lymph nodes, the internal iliac, obturator, common iliac, and external iliac lymph nodes are collectively referred to as the lateral pelvic lymph nodes [1]. At major hospitals in Japan, dissection of the lateral pelvic lymph nodes is indicated for patients with clinical stage II or III lower rectal cancer [2]. Moreover, dissection of other extramesorectal lymph nodes is also indicated for those with lymph node enlargement detected by preoperative or intraoperative examination. Among them, there are occasionally patients in whom mesorectal lymph node metastasis is absent and extramesorectal lymph node metastasis is present. Although the incidence and prognosis of rectal cancer patients with lateral pelvic lymph node metastasis have been reported [1, 3], those of rectal cancer patients with limited extramesorectal lymph node metastasis remain unclear. In the present study, therefore, I investigated this issue.
S. Fujita Colorectal Surgery Division, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan
Methods
S. Fujita (*) Department of Surgery, Tochigi Cancer Center, 9-13 Yonan 4-chome, Utsunomiya, Tochigi 320-0834, Japan e-mail: [email protected]
A total of 714 patients with clinical stage II or III lower rectal cancer who underwent extramesorectal lymph node dissection including lateral lymph node dissection at the National Cancer Center Hospital, Tokyo, between 1985 and 2011 were
1078
reviewed. In this study, extramesorectal lymph nodes were defined as lymph nodes in the pelvis and groin, which include the common iliac, internal iliac, external iliac, obturator, lateral sacral, presacral, sacral promontory, and inguinal lymph nodes. Lateral lymph node dissection is indicated for patients with clinical stage II or III rectal cancer where the lower margin is located at or below the peritoneal reflection [1]. Dissection of the other extramesorectal lymph nodes was performed for patients in whom lymph node enlargement was detected by preoperative or intraoperative examination. Among the 714 patients, 129 had pathologically confirmed extramesorectal lymph node metastasis. Among the 129 patients, 94 had mesorectal and extramesorectal lymph node metastasis and 35 had limited extramesorectal lymph node metastasis. Patients were followed up at three monthly intervals for 2 years, and at six monthly intervals thereafter. Tumor markers were examined at every patient visit. CT of the liver and lung or abdominal ultrasonography with chest X-ray was performed at least once every 6 months. Colonoscopy was performed twice within 5 years after surgery. The median follow-up time for the 35 patients was 5.8 years, and among them, 11 received adjuvant therapy (chemotherapy 5, chemoradiotherapy 3, radiotherapy 3). Statistical analysis Survival rates were calculated by the Kaplan-Meier method and differences were compared statistically by the log-rank test. Cox’s proportional hazards model was used for multivariate analysis. Data differences between groups were considered statistically significant at P
