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Rifu K, Koinuma K, Horie H, Mori K, Naoi D, Tojo M, Homma Y, Murahashi S, Kihara A, Mimura T, Kitayama J, Sata N. Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review. J Anus Rectum Colon 2024; 8:259-264. [PMID: 39086877 PMCID: PMC11286367 DOI: 10.23922/jarc.2024-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/11/2024] [Indexed: 08/02/2024] Open
Abstract
Lateral lymph node (LLN) metastasis in T1 rectal cancer has an incidence of less than 1%. However, its clinical features are largely uncharted. We report a case of LLN metastasis in T1 rectal cancer and review the relevant literature. A 56-year-old female underwent rectal resection for lower rectal cancer 2 years previously (pT1bN0M0). During follow-up, an elevated tumor marker CA19-9 was documented. Enhanced CT and MRI showed a round shape nodule 2 cm in size on the left side of pelvic wall. PET-CT showed high accumulation of FDG in the same lesion, leading to a diagnosis of isolated LLN recurrence. Because no other site of recurrence was detected, surgical resection of the LLN was performed. Microscopic findings were consistent with metastatic lymph node originating from the recent rectal cancer. Adjuvant chemotherapy for six months was given, and patient remains free of recurrent disease seven months after LLN resection. Although LLN recurrence after surgery for T1 rectal cancer is rare, post-surgical follow-up should not be omitted. When LLN metastasis is suspected on CT, MRI and/or PET-CT will be recommended. Surgical resection of LLN metastasis in patients with T1 rectal cancer may lead to favorable outcomes, when recurrence in other areas is not observed.
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Affiliation(s)
- Kazuma Rifu
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Koji Koinuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Katsusuke Mori
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Daishi Naoi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Mineyuki Tojo
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Yuko Homma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Satoshi Murahashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Atsushi Kihara
- Department of Pathology, Jichi Medical University Hospital, Tochigi, Japan
| | - Toshiki Mimura
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Joji Kitayama
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
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Uehara K, Ogura A, Murata Y, Sando M, Mukai T, Aiba T, Yamamura T, Nakamura M. Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries. Dig Endosc 2023; 35:243-254. [PMID: 36342054 DOI: 10.1111/den.14464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two-team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short- and medium-term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well-trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.
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Affiliation(s)
- Kay Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Atsushi Ogura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yuki Murata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masanori Sando
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Toshiki Mukai
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Toshisada Aiba
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Liu XW, Zhou B, Wu XY, Yu WB, Zhu RF. T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis: A case report. World J Clin Cases 2022; 10:12404-12409. [PMID: 36483826 PMCID: PMC9724534 DOI: 10.12998/wjcc.v10.i33.12404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are a few cases of lateral lymph node (LLN) metastasis (LLNM) of T1 rectal cancer. Moreover, LLNM is easily missed, especially in patients with early-stage rectal cancer. To our knowledge, the possibility of bilateral LLNM before surgery has not been reported in previous studies.
CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp. The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma. She was considered to have bilateral LLNM after the examination at our hospital. Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM. The patient received long-course adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.
CONCLUSION T1 rectal cancer could lead to LLNM and possibly, bilateral LLNM. Therefore, adequate clinical evaluation is essential for these patients.
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Affiliation(s)
- Xian-Wei Liu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Bing Zhou
- Department of Pathology, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Xiao-Yu Wu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Wen-Bing Yu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Ren-Fang Zhu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
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Ichihara M, Ikeda M, Uemura M, Miyake M, Miyazaki M, Kato T, Sekimoto M. Feasibility and safety of laparoscopic lateral pelvic lymph node dissection for locally recurrent rectal cancer and risk factors for re-recurrence. Asian J Endosc Surg 2020; 13:489-497. [PMID: 31854108 DOI: 10.1111/ases.12778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lateral pelvic lymph node (LPLN) metastasis is considered a distant metastasis. It is often treated by systemic chemotherapy and/or radiation therapy, but complete radical resection of LPLN metastasis can sometimes achieve cure. However, the safety and efficacy of radical resection for recurrent LPLN after curative rectal surgery have not been well elucidated. Therefore, we evaluated the feasibility of laparoscopic radical surgery for recurrent LPLN compared with the conventional open approach and assessed oncological outcomes between patients with and without re-recurrence. METHODS We retrospectively reviewed 17 cases (4 open, 13 laparoscopic) who underwent radical resection for LPLN metastasis after curative rectal surgery between July 2012 and August 2016 at the National Hospital Organization Osaka National Hospital. Operative factors and short-term outcomes were compared. Oncological outcome was evaluated based on the pathologic response to preoperative adjuvant therapy. RESULTS The laparoscopic group's median blood loss and C-reactive protein elevation were lower than that of the open group on postoperative day 3. The laparoscopic group also had a shorter postoperative hospital stay. The median operative time, R0 resection rate, and morbidity rate were similar between the two groups. Local re-recurrence after LPLN resection occurred more frequently in pathologic non-responders than responders. CONCLUSION Laparoscopic surgery for LPLN metastasis is feasible and less invasive than open surgery. Laparoscopic radical resection of LPLN may be justified for curative intent. Patients with incomplete pathologic response to neoadjuvant therapy have a greater risk of re-recurrence.
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Affiliation(s)
- Momoko Ichihara
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masataka Ikeda
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Division of Lower Gastrointestinal, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Surgery, Kansai Medical University, Hirakata, Japan
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Tanishima H, Kimura M, Tominaga T, Iwakura S, Hoshida Y, Horiuchi T. Lateral lymph node metastasis in a patient with T1 upper rectal cancer treated by lateral lymph node dissection: a case report and brief literature review. Surg Case Rep 2017; 3:93. [PMID: 28836143 PMCID: PMC5568184 DOI: 10.1186/s40792-017-0366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022] Open
Abstract
Background Lateral lymph node (LLN) metastasis may occur in patients with advanced rectal cancers of which the lower margins are located at or below the peritoneal reflection. However, LLN metastasis from a T1 rectal cancer is rare. Here, we report a case of LLN metastasis from a T1 upper rectal cancer that was successfully treated by sequential LLN dissection. Case presentation A 56-year-old man was referred to our hospital for the treatment of a T1 upper rectal cancer. We performed a laparoscopic low anterior resection. Histological examination showed a moderately differentiated adenocarcinoma with submucosal layer invasion; the invasion depth was classified as head invasion, without vessel or lymph duct invasion. Tumor budding was classified as grade 1. A total of six lymph nodes were harvested, and no lymph node metastases were detected. The postoperative course was uneventful. At 6 months after surgery, however, the serum carcinoembryonic antigen levels were elevated, and abdominal computed tomography (CT) revealed swollen lymph nodes in the right internal and common iliac artery area. Positron emission tomography with CT revealed hot spots in the same lesions. A retrospective re-evaluation of the preoperative CT images revealed no apparent swollen lymph nodes; however, an unusual soft tissue area was detected around the right internal iliac artery. A right LLN dissection was performed. Fifteen lymph nodes were resected, and histologically, metastases of adenocarcinoma were identified in 3 nodes. The postoperative course was again uneventful. The patient was given 12 cycles of adjuvant chemotherapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin). The patient remains healthy and with no signs of recurrence at 30 months after the second surgery. Conclusions LLN metastasis occurs very rarely in patients with T1 upper rectal cancer and no risk factors for lymph node metastasis; however, a careful perioperative examination of the LLN should be performed. In cases involving LLN metastasis, a LLN dissection may be a therapeutic option if performed with curative intent.
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Affiliation(s)
- Hiroyuki Tanishima
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan.
| | - Masamichi Kimura
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Toshiji Tominaga
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Shinji Iwakura
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Yoshihiko Hoshida
- Department of Pathology, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Tetsuya Horiuchi
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
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Therapeutic Importance of Endoscopic Pathology Versus Magnetic Resonance Imaging Findings for T1 Rectal Cancer: A Case Report. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00099.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Preoperative image-based diagnosis is important for the treatment of rare cases of T1 lower rectal cancers with lateral pelvic lymph node (LLN) metastasis. We report a case of LLN metastasis in T1 lower rectal cancer diagnosed preoperatively via magnetic resonance imaging (MRI). A 65-year-old woman was admitted to our hospital because of abdominal pain. An endoscopic examination revealed a large laterally spreading tumor in the lower rectum, which was en bloc resected using endoscopic submucosal dissection. Pathologic examination of the resected specimen showed deep invasion of the cancer cells into the submucosal layer and lymphovascular invasion. MRI revealed swollen perirectal lymph nodes (≥5 mm) and a left LLN approximately 8 mm long. Laparoscopic abdominoperineal resection (Lap-APR) with left lateral pelvic lymph node dissection (LLND) was performed. Cancer cells were not seen in the resected material; however, 7 perirectal lymph nodes and 1 LLN of 47 lymph nodes contained metastatic cancer cells. We show that LLN metastasis in T1 lower rectal cancer can be preoperatively detected via MRI and successfully and safely treated via Lap-APR with left LLND.
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Bae SU, Saklani AP, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series. Ann Surg Treat Res 2014; 86:76-82. [PMID: 24761412 PMCID: PMC3994600 DOI: 10.4174/astr.2014.86.2.76] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/20/2013] [Accepted: 10/24/2013] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer. METHODS Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation. RESULTS All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170-581 minutes) and estimated blood loss was 200 mL (range, 50-700 mL). The median length of stay was 10 days (range, 5-24 days) and time to removal of the urinary catheter was 3 days (range, 1-21 days). The median total number of lymph nodes harvested was 24 (range, 8-43), and total number of lateral pelvic lymph nodes was 7 (range, 2-23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence. CONCLUSION Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND.
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Affiliation(s)
- Sung Uk Bae
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Avanish P Saklani
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Case of isolated lateral lymph node recurrence occurring after TME for T1 lower rectal cancer treated with lateral lymph node dissection: report of a case. Surg Today 2012; 43:809-13. [PMID: 22832928 DOI: 10.1007/s00595-012-0266-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/24/2012] [Indexed: 12/20/2022]
Abstract
We experienced a rare case of isolated lateral lymph node (LLN) recurrence after laparoscopic intersphincteric resection with total mesorectal excision for T1 lower rectal cancer that was successfully treated using LLN dissection with en bloc resection of the left superior vesical artery, the left ovary and the left obturator nerve, artery and vein. There are no guidelines for treating patients with isolated LLN recurrence because isolated LLN recurrence is rare, especially in patients with T1 rectal cancer. However, in patients with pT1N0 lower rectal cancer, follow-up examinations of the pelvis should be performed periodically. Patients with isolated LLN recurrence treated with surgery might have good long-term prognoses. Therefore, for such patients, surgical resection should be considered as a curative treatment only.
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