Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Downstaged lateral pelvic lymph nodes require no resection after neoadjuvant therapy and total mesorectal excision.
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Gomaa Ibrahim A, Aboelmaaty Sara, Sassun Richard, Sileo Annaclara, Ng Jyi Cheng, Keshk Nouran O, Mathis Kellie L, Dozois Eric J, Perry William R G, Larson David W
Аннотация
BACKGROUND: This study evaluated lateral lymph node (LLN) downstaging on restaging magnetic resonance imaging (MRI) and its impact on local recurrence (LR) in patients with stage 3 rectal cancer undergoing neoadjuvant therapy followed by curative surgery.
METHODS: This was a retrospective review of adult patients with stage 3 rectal cancer who underwent neoadjuvant therapy followed by curative surgery between 2014 and 2023 at a high-volume center. Patients were divided into 2 groups based on LLN status: patients with negative LLN on baseline MRI (group 1) and patients with positive LLN on baseline MRI, which downstaged to negative on restaging MRI (group 2).
RESULTS: A total of 397 patients (group 1, 310; group 2, 87) underwent curative surgery for locally advanced rectal cancer. There were no significant differences between both groups regarding age, sex, body mass index, mesorectal fascia involvement, and clinical T stage. However, a significantly lower proportion of group 1 patients received total neoadjuvant therapy as neoadjuvant treatment than group 2 patients (43.5% vs 62.1%; P =.002). Group 2 had a significantly higher proportion of LLN dissection (LLND) (2.9% vs 17.2%; P <.001). However, all the surgically removed LLNs were negative for tumors. At 5-year follow-up, Kaplan-Meier curves demonstrated that there was no significant difference between both groups in LR rate (2.3% vs 4.6%; P =.21), LLN recurrence rate (0.6% vs 1.1%; P =.61), and disease-free survival (83.9% vs 86.2%; P =.61).
CONCLUSION: Observation rather than LLND may be appropriate for patients with downstaged LLNs based on restaging MRI findings after neoadjuvant therapy.
METHODS: This was a retrospective review of adult patients with stage 3 rectal cancer who underwent neoadjuvant therapy followed by curative surgery between 2014 and 2023 at a high-volume center. Patients were divided into 2 groups based on LLN status: patients with negative LLN on baseline MRI (group 1) and patients with positive LLN on baseline MRI, which downstaged to negative on restaging MRI (group 2).
RESULTS: A total of 397 patients (group 1, 310; group 2, 87) underwent curative surgery for locally advanced rectal cancer. There were no significant differences between both groups regarding age, sex, body mass index, mesorectal fascia involvement, and clinical T stage. However, a significantly lower proportion of group 1 patients received total neoadjuvant therapy as neoadjuvant treatment than group 2 patients (43.5% vs 62.1%; P =.002). Group 2 had a significantly higher proportion of LLN dissection (LLND) (2.9% vs 17.2%; P <.001). However, all the surgically removed LLNs were negative for tumors. At 5-year follow-up, Kaplan-Meier curves demonstrated that there was no significant difference between both groups in LR rate (2.3% vs 4.6%; P =.21), LLN recurrence rate (0.6% vs 1.1%; P =.61), and disease-free survival (83.9% vs 86.2%; P =.61).
CONCLUSION: Observation rather than LLND may be appropriate for patients with downstaged LLNs based on restaging MRI findings after neoadjuvant therapy.