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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer
Hiroshi Tamura, Yoshifumi Shimada, Hitoshi Kameyama, Ryoma Yagi, Yosuke Tajima, Takuma Okamura, Mae Nakano, Masato Nakano, Masayuki Nagahashi, Jun Sakata, Takashi Kobayashi, Shin-ichi Kosugi, Hitoshi Nogami, Satoshi Maruyama, Yasumasa Takii, Toshifumi Wakai
Hiroshi Tamura, Yoshifumi Shimada, Hitoshi Kameyama, Ryoma Yagi, Yosuke Tajima, Takuma Okamura, Mae Nakano, Masato Nakano, Masayuki Nagahashi, Jun Sakata, Takashi Kobayashi, Toshifumi Wakai, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
Shin-ichi Kosugi, Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma 949-7302, Japan
Hitoshi Nogami, Satoshi Maruyama, Yasumasa Takii, Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8586, Japan
Author contributions: Tamura H and Shimada Y designed the report; Kameyama H, Tajima Y, Okamura T, Nakano M, Nakano M, Nagahashi M, Sakata J, Kobayashi T, Kosugi S, Nogami H, Maruyama S and Takii Y were attending doctors for the patients and performed surgical operation; Tamura H and Yagi R collected the patient’s clinical data; Tamura H and Shimada Y analyzed the data and wrote the paper; Wakai T approved the final version of the manuscript.
Institutional review board statement: This study was performed in accordance with the Helsinki Declaration, and the Ethics Committee of the School of Medicine. Niigata University approved the study protocol (approval number: 2330).
Informed consent statement: Niigata University approved the study protocol (approval number: 2330), waiving patient consent.
Conflict-of-interest statement: This study has no commercial interest, financial, or material support.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshifumi Shimada, MD, PhD, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
shimaday@med.niigata-u.ac.jp
Telephone: +81-25-2272228 Fax: +81-25-2270779
Received: March 23, 2017
Peer-review started: March 24, 2017
First decision: May 10, 2017
Revised: May 27, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: October 10, 2017
Processing time: 186 Days and 16.1 Hours
AIM
To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer.
METHODS
We selected 71 consecutive stage IV low rectal cancer patients who underwent primary tumor resection, and enrolled 50 of these 71 patients without clinical LPLN metastasis. The patients had distant metastasis such as liver, lung, peritoneum, and paraaortic LN. Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan. All patients underwent primary tumor resection, 27 patients underwent total mesorectal excision (TME) with LPLND (LPLND group), and 23 patients underwent only TME (TME group). Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group. R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients. We evaluated possible prognostic factors for 5-year overall survival (OS), and compared 5-year cumulative local recurrence between the LPLND and TME groups.
RESULTS
For OS, univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%, P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor. Regarding cumulative local recurrence, the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%, P = 0.833).
CONCLUSION
Prophylactic LPLND shows no oncological benefits in patients with Stage IV low rectal cancer without clinical LPLN metastasis.
Core tip: The clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer has not been proven. In this study, we showed two main findings concerning treatment strategy in these patients. First, prophylactic LPLND was not a significant prognostic factor for overall survival and did not contribute local control. Second, R0 resection was an independent prognostic factor for overall survival. These results suggest that prophylactic LPLND is not an important component of surgical treatment in stage IV low rectal cancer patients.
