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Additional Surgery May Reduce Lateral Local Recurrence of Rectal Cancer

By: Celeste L. Dixon
Posted: Monday, January 7, 2019

In addition to treatment with neoadjuvant chemoradiotherapy and total mesorectal excision, lateral lymph node dissection (LLND) significantly reduced the rate of lateral local recurrence of low cT3/4 rectal cancer in certain patients, according to a retrospective analysis published in the Journal of Clinical Oncology. Specifically, for those patients whose lateral lymph nodes with a short axis of at least 7 mm, the 5-year lateral local recurrence rate for those who had LLND was 5.7%, versus 19.5% for those who did not (P = .042).

Atsushi Ogura, MD, of Leiden University Medical Center, the Netherlands, and an international team evaluated data on 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery over a 5-year period. Of them, 703 patients (58%) had visible lateral lymph nodes; 192 (16%) had a short axis of at least 7 mm.

After neoadjuvant chemoradiotherapy and total mesorectal excision, 142 of the total patients had LLND. Also, 108 of the total patients had local tumor recurrence, including 59 with lateral local recurrence, for a 5-year lateral local recurrence rate of 5.5%.  Multivariable analyses indicated that patients with lateral lymph nodes that had a short axis of at least 7 mm (versus less than 7 mm) had a significantly higher risk of lateral local recurrence (P = .045).

More than half of patients with enlarged lateral lymph nodes, wrote Dr. Ogura and colleagues, “will develop [local recurrence] in the same compartment, which suggests that complete LLND is required.” To further determine the benefit of LLND in varying scenarios, the team suggests “a large prospective multicenter study, with high-volume referral centers for locally advanced rectal cancers, where expertise in optimal radiotherapy regimens and surgical expertise in LLND can be standardized and quality controlled.”

Disclosure: The study authors’ disclosure information may be found at ascopubs.org.



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