Results of a Japanese Nationwide Multi-Institutional Study on Lateral Pelvic Lymph Node Metastasis in Low Rectal Cancer Is It Regional or Distant Disease?

被引:265
作者
Akiyoshi, Takashi [2 ]
Watanabe, Toshiaki [1 ]
Miyata, Satoshi [3 ]
Kotake, Kenjiro [4 ]
Muto, Tetsuichiro [2 ]
Sugihara, Kenichi [5 ]
机构
[1] Univ Tokyo, Dept Surg Oncol, Bunkyo Ku, Tokyo 1138655, Japan
[2] Japanese Fdn Canc Res, Gastroenterol Ctr, Dept Gastroenterol Surg, Canc Inst Hosp, Tokyo, Japan
[3] Japanese Fdn Canc Res, Genome Ctr, Bioinformat Grp, Canc Inst Hosp, Tokyo, Japan
[4] Tochigi Canc Ctr, Dept Surg, Utsunomiya, Tochigi, Japan
[5] Tokyo Med & Dent Univ, Dept Surg Oncol, Tokyo, Japan
关键词
PERITONEAL REFLECTION; MESORECTAL EXCISION; SIDEWALL DISSECTION; LOCAL RECURRENCE; CHEMORADIOTHERAPY; LYMPHADENECTOMY; INVOLVEMENT; CARCINOMA; REGISTRY; BENEFIT;
D O I
10.1097/SLA.0b013e3182565d9d
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Objective: To evaluate whether lateral pelvic lymph nodes (LNs) in low rectal cancer are metastatic disease or part of regional LNs that are amenable to curative resection. Background: It is highly controversial whether lateral pelvic LNs should be considered as regional or distant disease, although the American Joint Committee on Cancer (AJCC) defines internal iliac LNs as regional LNs of rectal cancer. Methods: Data of patients with stage I to III low rectal cancer who underwent curative resection from 1978 to 1998 were extracted from the multi-institutional registry of large bowel cancer in Japan. Patients with only mesorectal LN metastasis were classified as the mesorectal-LN group. Patients with lateral pelvic LN metastasis localized to or extending beyond the internal iliac area were classified as the internal lateral pelvic lymph nodes (LPLN) group and external-LPLN group, respectively. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups. Results: Lateral pelvic LN dissection was performed in 5789 (50%) of 11,567 patients. Overall, 3905 (34%), 411 (3.6%), and 244 (2.1%) patients were classified as the mesorectal-LN, internal-LPLN, and external-LPLN groups, respectively. When the mesorectal LN group was subdivided as defined by the AJCC, both 5-year OS and CSS were not significantly different between the N2a and internal-LPLN groups (OS: 45% vs 45%, P = 0.9585; CSS: 51% vs 49%, P = 0.5742), and the N2b and external-LPLN groups (OS: 32% vs 29%, P = 0.3342; CSS: 37% vs 34%, P = 0.4347). OS and CSS were significantly better in the external-LPLN group than in stage IV patients who underwent curative resection (OS: 29% vs 24%, P = 0.0240; CSS: 34% vs 27%, P = 0.0117). Conclusions: Lateral pelvic LNs can be considered as regional LNs in low rectal cancer, although metastasis extending beyond the internal iliac area is associated with poorer survival.
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收藏
页码:1129 / 1134
页数:6
相关论文
共 26 条
[1]
Adjuvant chemotherapy with uracil-tegafur for pathological stage III rectal cancer after mesorectal excision with selective lateral pelvic lymphadenectomy: A multicenter randomized controlled trial [J].
Akasu, Takayuki ;
Moriya, Yoshihiro ;
Ohashi, Yasuo ;
Yoshida, Shigeaki ;
Shirao, Kuniaki ;
Kodaira, Susumu .
JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 2006, 36 (04) :237-244
[2]
[Anonymous], 2009, JAP CLASS COL CARC
[3]
Edge S.B., 2010, AJCC cancer staging manual, V649
[4]
EN-BLOC PELVIC LYMPHADENECTOMY AND SPHINCTER PRESERVATION IN THE SURGICAL-MANAGEMENT OF RECTAL-CANCER [J].
ENKER, WE ;
HEILWEIL, ML ;
HERTZ, REL ;
PILIPSHEN, SJ ;
STEARNS, MW ;
STERNBERG, SS ;
JANOV, AJ .
ANNALS OF SURGERY, 1986, 203 (04) :426-433
[5]
Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis [J].
Georgiou, Panagiotis ;
Tan, Emile ;
Gouvas, Nikolaos ;
Antoniou, Anthony ;
Brown, Gina ;
Nicholls, R. John ;
Tekkis, Paris .
LANCET ONCOLOGY, 2009, 10 (11) :1053-1062
[6]
Hida J, 1997, J AM COLL SURGEONS, V184, P475
[7]
Japanese Society for Cancer of the Colon and Rectum, 1997, JAP CLASS COL CARC
[8]
Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer [J].
Kim, Jin C. ;
Takahashi, Keiichi ;
Yu, Chang S. ;
Kim, Hee C. ;
Kim, Tae W. ;
Ryu, Min H. ;
Kim, Jong H. ;
Mori, Takeo .
ANNALS OF SURGERY, 2007, 246 (05) :754-762
[9]
Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection [J].
Kim, Tae Hyun ;
Jeong, Seung-Yong ;
Choi, Dong Hyun ;
Kim, Dae Yong ;
Jung, Kyung Hae ;
Moon, Sung Ho ;
Chang, Hee Jin ;
Lim, Seok-Byung ;
Choi, Hyo Seong ;
Park, Jae-Gahb .
ANNALS OF SURGICAL ONCOLOGY, 2008, 15 (03) :729-737
[10]
Outcomes of Surgery Alone for Lower Rectal Cancer With and Without Pelvic Sidewall Dissection [J].
Kobayashi, Hirotoshi ;
Mochizuki, Hidetaka ;
Kato, Tomoyuki ;
Mori, Takeo ;
Kameoka, Shingo ;
Shirouzu, Kazuo ;
Sugihara, Kenichi .
DISEASES OF THE COLON & RECTUM, 2009, 52 (04) :567-576