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Association of Lateral Pelvic Lymph Nodes with Disease Recurrence and Organ Preservation in Patients with Distal
Nathalie R A Beets1, Floris S Verheij1, Hannah Williams1
1Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Annals of Surgery
|April 22, 2024
Summary
Enlarged lateral lymph nodes (LLN) in rectal cancer do not predict recurrence or metastasis after total neoadjuvant therapy (TNT). However, persistent LLN after TNT negatively impacts organ preservation, suggesting limited benefit from lateral node dissection.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Optimal management of rectal adenocarcinoma with enlarged lateral lymph nodes (LLN) remains debated.
- Lateral lymph node involvement is a critical factor in rectal cancer staging and treatment planning.
Purpose of the Study:
- To evaluate the prognostic significance of enlarged lateral lymph nodes (LLN) in rectal cancer patients.
- To assess the impact of LLN on disease recurrence, metastasis, and organ preservation following total neoadjuvant therapy (TNT).
Main Methods:
- Post hoc analysis of the OPRA trial data involving patients with rectal cancer treated with TNT.
- Assessment of visible LLN (LLN+), LLN size (≥7 mm baseline, ≥4 mm restaging) on MRI.
- Correlation of LLN status with recurrence, metastasis, and rectum preservation rates.
Main Results:
- Enlarged lateral lymph nodes (LLN) were present in 18% of patients at baseline.
- LLN involvement did not correlate with increased rates of local recurrence or distant metastasis.
- Persistent LLN (≥4 mm) after TNT was significantly associated with lower rates of organ preservation (P=0.013).
- Disease recurrence within LLN was rare and associated with distant metastasis.
Conclusions:
- Lateral lymph node (LLN) status is not a significant predictor of recurrence or metastasis in rectal cancer patients treated with TNT.
- Persistent LLN after TNT negatively impacts the ability to preserve the rectum.
- Lateral lymph node dissection appears to benefit only a small subset of patients, warranting careful consideration.
