Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting.
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Sluckin Tania C, Hazen Sanne-Marije J A, Horsthuis Karin, Beets-Tan Regina G H, Aalbers Arend G J, Beets Geerard L, Boerma Evert-Jan G, Borstlap Jaap, van Breest Smallenburg Vivian, Burger Jacobus W A, Crolla Rogier M P H, Daniëls-Gooszen Alette W, Davids Paul H P, Dunker Michalda S, Fabry Hans F J, Furnée Edgar J B, van Gils Renza A H, de Haas Robbert J, Hoogendoorn Stefan, van Koeverden Sebastiaan, de Korte Fleur I, Oosterling Steven J, Peeters Koen C M J, Posma Lisanne A E, Pultrum Bareld B, Rothbarth Joost, Rutten Harm J T, Schasfoort Renske A, Schreurs Wilhelmina H, Simons Petra C G, Smits Anke B, Talsma Aaldert K, The G Y Mireille, van Tilborg Fiek, Tuynman Jurriaan B, Vanhooymissen Inge J S, van de Ven Anthony W H, Verdaasdonk Emiel G G, Vermaas Maarten, Vliegen Roy F A, Vogelaar F Jeroen, de Vries Marianne, Vroemen Joy C, van Vugt Sebastiaan T, Westerterp Marinke, van Westreenen Henderik L, de Wilt Johannes H W, van der Zaag Edwin S, Zimmerman David D E, Marijnen Corrie A M, Tanis Pieter J, Kusters Miranda, Dutch Snapshot Research Group
Аннотация
METHODS: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either 'node-picking' (the removal of an individual LLN) or 'partial regional node dissection' (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection.
RESULTS: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7-3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2-2.5, p = 0.874).
CONCLUSION: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.