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Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer
Shin Fujita1, Junki Mizusawa, Yukihide Kanemitsu
1*Department of Surgery, Tochigi Cancer Center, Tochigi, Japan †JCOG Data Center/Operations Office, National Cancer Center, Tokyo, Japan ‡Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan §Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan ¶Department of Surgery, Shizuoka Cancer Center, Shizuoka, Japan ||Department of Surgery, Aichi Cancer Center Hospital, Nagoya, Japan **Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan ††Department of Surgery, Yokohama City University Medical Center, Kanagawa, Japan ‡‡Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan §§Department of Surgery, Kanagawa Cancer Center, Kanagawa, Japan ¶¶Department of Surgery, Kyoto Medical Center, Kyoto, Japan ||||Department of Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan ***Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan †††Department of Surgery, Suita Municipal Hospital, Osaka, Japan ‡‡‡Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan §§§Department of Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan ¶¶¶Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan ||||||Hospital of the Imperial Household, Tokyo, Japan ****Japanese Red Cross Medical Center, Tokyo, Japan.
Mesorectal excision (ME) alone was not confirmed as noninferior to ME with lateral lymph node dissection (LLND) for rectal cancer. ME with LLND demonstrated a reduced local recurrence rate, particularly in the lateral pelvis.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Rectal Cancer Treatment
Background:
- Lateral pelvic lymph node metastasis is observed in clinical stage II/III lower rectal cancer.
- Mesorectal excision with lateral lymph node dissection (ME with LLND) is standard in Japan.
- Mesorectal excision (ME) alone is the international standard surgical procedure.
Purpose of the Study:
- To confirm the noninferiority of ME alone compared to ME with LLND in efficacy for rectal cancer.
- Evaluate relapse-free survival as the primary endpoint.
- Assess overall survival and local-recurrence-free survival as secondary endpoints.
Main Methods:
- A randomized controlled trial involving 701 patients with clinical stage II/III rectal cancer.
- Patients were allocated to ME with LLND or ME alone.
- Intention-to-treat analysis with a primary endpoint of 5-year relapse-free survival.
Main Results:
- 5-year relapse-free survival was 73.4% for ME with LLND and 73.3% for ME alone (HR 1.07).
- 5-year local-recurrence-free survival was 87.7% for ME with LLND and 82.4% for ME alone (P=0.024).
- ME with LLND showed significantly lower local recurrence rates (7.4% vs 12.6%).
Conclusions:
- The noninferiority of ME alone to ME with LLND was not confirmed.
- ME with LLND resulted in a lower rate of local recurrence compared to ME alone.
- ME with LLND may be advantageous for reducing local recurrence in the lateral pelvis for rectal cancer patients.
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