Lateral Node Dissection in Locally Advanced Rectal Cancer with Radiologically Detected Extramesorectal Node Metastasis
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- Category: Vol. 82, March 2014
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Lateral Node Dissection in Locally Advanced Rectal Cancer with Radiologically Detected Extramesorectal Node Metastasis, WAEL S. ABDEL GAWAD, IMAN M. GOUDA and AMR A. SHABANA
Abstract
Rationale: The incidence of lateral node metastasis in rectal cancer ranges from 10-23%. Patients with lateral node deposits show poor outcome, yet lateral node dissection may provide a favorable prognostic value with respect to local disease control.
Aim: The purpose of the study is to evaluate the clinical outcome of patients that underwent lateral node dissection for radiologically detected extramesorectal nodes.
Methods: This study ran from 2007 through 2011 and involved 75 patients with stage II and III rectal cancer who received neoadjuvant long course chemoradiation followed by total mesorectal excision and concomitant lateral node dissection for radiologically detected extramesorectal nodal metastasis. MRI and multi detector CT were used to assess primary tumour stage, lateral, mesorectal and paraaortic lymph nodes. Lymph nodes larger than 0.5cm at the short-axis diameter, with speculated edges or heterogenic pattern was considered malignant. PET CT was used in uncertain diagnosis.
Results: The perioperative mortality occurred in 3% and surgical morbidity in 16%. The positive predictive value (PPV) for the radiologically diagnosed extramesorectal nodal metastasis was 93.3% for lateral nodes and 55% for the para-aortic and mesorectal nodes. Pathological examination revealed N0 in 26%, positive lateral (LA), Mesorectal & Para-aortic (MP), lateral and mesorectal-paraaortic nodes (LA&MP) (26%-33% and 15%) respectively. The 5-year cancer specific survival rate in patients with lateral, Mesorectal, lateral and Mesorectal nodes was (46.2%, 43.1% and 18.3%). The 5-year disease free survival (DSF) in patients with the same groups was (39.3%, 32% and 16.1%) respectively.
Conclusion: The prognostic significance, the associated morbidity and the false positive results of radiological diagnosis of lateral node disease should decide the role of lateral node dissection in rectal cancer.