Медицинская библиотека · Annals of surgical oncology · 2023

Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting.

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

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Аннотация

BACKGROUND

Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level.

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.

Для цитирования: 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. Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting.. Annals of surgical oncology. 2023. DOI: 10.1245/s10434-023-13460-0.

Предметные рубрики MeSH

Humans Lymph Node Excision Cross-Sectional Studies Lymph Nodes Rectal Neoplasms Rectum Retrospective Studies Neoplasm Recurrence, Local Neoplasm Staging

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