Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Stage IV low rectal cancer presents unique challenges, often involving distant metastasis.
• Lateral pelvic lymph node metastasis is a potential concern in these patients.
• The role of prophylactic lateral pelvic lymph node dissection (LPLND) in improving outcomes is debated.

Purpose of the Study:

• To evaluate the clinical significance of prophylactic LPLND in patients with stage IV low rectal cancer.
• To compare oncological outcomes, including overall survival and local recurrence, between patients who underwent LPLND and those who did not.

Main Methods:

• A cohort of 71 patients with stage IV low rectal cancer was retrospectively analyzed.
• 50 patients without clinical lateral pelvic lymph node metastasis were included in the comparison.
• Patients underwent either total mesorectal excision (TME) with LPLND (n=27) or TME alone (n=23).

Main Results:

• No significant difference in 5-year overall survival was observed between the LPLND and TME groups (28.7% vs 17.0%, P=0.523).
• Multivariate analysis identified R0 resection as the only independent prognostic factor for survival.
• Cumulative local recurrence rates were similar between the groups (21.4% vs 14.8%, P=0.833).

Conclusions:

• Prophylactic LPLND does not provide oncological benefits for stage IV low rectal cancer patients without clinical lateral pelvic lymph node metastasis.
• Complete resection of primary and metastatic tumors (R0 resection) is crucial for improving survival in this patient population.