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Updated: Mar 12, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Clinically Node Negative, Pathologically Node Positive Rectal Cancer Patients Who Did Not Receive Neoadjuvant Therapy
Nouf Akeel1,2, Nan Lan1, Luca Stocchi3
1Department of Colorectal Surgery, Cleveland Clinic, Desk A 30, 9500 Euclid Ave. A30, Cleveland, OH, 44195, USA.
For rectal cancer patients with clinically node-negative but pathologically stage III disease, surgery alone is insufficient. Adjuvant therapy improves outcomes compared to surgery alone for these patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Neoadjuvant chemoradiotherapy is standard for clinical stages II-III rectal cancer.
- Optimal treatment for clinically node-negative (cN-) but pathologically stage III (pN+) rectal cancer remains uncertain.
- This study investigates outcomes for cN-/pN+ rectal cancer patients treated with surgery alone versus those receiving adjuvant therapy.
Purpose of the Study:
- To evaluate the oncological outcomes of clinically node-negative (cN-) rectal cancer patients who are found to have pathologically stage III (pN+) disease after surgery.
- To compare outcomes of cN-/pN+ patients treated with surgery alone versus those receiving adjuvant therapy.
- To establish optimal treatment strategies for this specific patient subgroup.
Main Methods:
- Retrospective analysis of 218 rectal cancer patients with pN+ disease from 2000-2012.
- Patients were categorized into three groups: surgery alone (cN-/pN+), surgery plus adjuvant therapy (cN-/pN+), and neoadjuvant chemoradiotherapy plus surgery (ypN+).
- Oncological outcomes including overall survival, disease-specific survival, disease-free survival, local recurrence, and distant recurrence were compared.
Main Results:
- Of 218 patients, 77 were cN-/pN+. 18 received no adjuvant therapy, 59 received adjuvant therapy, and 141 were in the ypN+ control group.
- Patients treated with surgery alone (cN-/pN+) had significantly poorer oncological outcomes compared to those receiving adjuvant therapy or neoadjuvant chemoradiotherapy.
- Resection margins and TME grading were comparable across groups.
Conclusions:
- Total mesorectal excision (TME) surgery alone is insufficient for rectal cancer patients with cN-/pN+ disease.
- Adjuvant therapy is crucial for improving oncological outcomes in this patient group.
- Current treatment paradigms may need adjustment for cN-/pN+ rectal cancer patients.
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