Related Experiment Video
Updated: Jun 13, 2026
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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Ten-Year Outcomes of Patients with Rectal Cancer Remaining Lymph Node Positive After Preoperative Radiochemotherapy
Sigmar Stelzner1,2, Stefan Niebisch1, Erik Puffer3
1Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany.
Cancers
|June 12, 2026
Summary
Persistent lymph node metastases after neoadjuvant radiochemotherapy (RCT) indicate poor treatment response in rectal cancer. Patients with residual nodal disease show similar outcomes to those treated upfront, highlighting a high-risk subgroup needing predictive markers.
Area of Science:
- Colorectal Surgery
- Oncology
- Radiation Oncology
Background:
- Persistent lymph node metastases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer signify a poor treatment response.
- Evaluating long-term outcomes for patients with residual nodal disease post-neoadjuvant RCT and total mesorectal excision (TME) is crucial.
Purpose of the Study:
- To compare the long-term prognosis of patients with residual nodal disease after neoadjuvant RCT and TME versus those undergoing upfront TME without adjuvant radiotherapy.
- To identify characteristics of patients with persistent nodal metastases and their impact on survival outcomes.
Main Methods:
- Retrospective analysis of consecutive rectal adenocarcinoma patients with confirmed lymph node metastases post-TME.
- Comparison of neoadjuvant radiochemotherapy (RCT) group (n=101) versus upfront surgery group (n=54), excluding distant metastases, in-hospital mortality, or postoperative radiotherapy.
- Kaplan-Meier analysis for local recurrence, time to recurrence, cancer-specific survival, and overall survival.
Main Results:
- Ten-year local recurrence rates were similar between the RCT and upfront surgery groups (21.0% vs. 20.8%).
- No significant differences were found in time to recurrence or cancer-specific survival between the groups.
- Overall survival was lower in the upfront surgery group, likely due to a higher median patient age.
Conclusions:
- Patients with persistent ypN-positive disease after neoadjuvant treatment have outcomes comparable to node-positive patients treated with upfront surgery, indicating a biologically high-risk subgroup.
- Non-response to neoadjuvant therapy suggests negative selection, potentially leading to missed opportunities for optimal local control.
- Urgent need for reliable predictive markers to identify non-responders and guide individualized treatment strategies for rectal cancer.
