Association of lateral pelvic lymph nodes with disease recurrence and organ preservation in patients with distal rectal adenocarcinoma treated with total neoadjuvant therapy Journal Article
| Authors: | Beets, N. R. A.; Verheij, F. S.; Williams, H.; Omer, D. M.; Lin, S. T.; Qin, L. X.; Beets, G. L.; Beets-Tan, R. G. H.; Wei, I. H.; Widmar, M.; Pappou, E. P.; Weiser, M. R.; Nash, G. M.; Smith, J. J.; Paty, P. B.; Miranda, J.; Kim, T. H.; Gollub, M. J.; Garcia-Aguilar, J. |
| Article Title: | Association of lateral pelvic lymph nodes with disease recurrence and organ preservation in patients with distal rectal adenocarcinoma treated with total neoadjuvant therapy |
| Abstract: | Objective: To assess the significance of enlarged lateral lymph nodes (LLN) for disease recurrence, metastasis, and organ preservation in patients with rectal cancer. Background: Optimal treatment of rectal adenocarcinoma involving LLN is subject to debate. Methods: A post hoc analysis of the Organ Preservation in Rectal Adenocarcinoma trial, a multicenter study of patients with rectal cancer treated with total neoadjuvant therapy (TNT) followed by total mesorectal excision or watch-and-wait management. We analyzed the association of visible LLN (LLN+), LLN ≥7 mm (short axis) on baseline magnetic resonance imaging (MRI), and LLN ≥4 mm on restaging MRI with recurrence, metastasis, and rectum preservation. Results: At baseline, 57 out of 324 (18%) patients had LLN+. In 30 (53%) of 57 patients with LLN+ on baseline MRI, the LLN disappeared after TNT. Disease recurrence in LLN was rare (3.5% of patients with LLN+ and 0.4% of patients with LLN-). All patients with recurrence in LLN also had distant metastasis. The rate of organ preservation was significantly lower in patients with LLN ≥4 mm on restaging MRI (P = 0.013). We found no significant differences in rates of local recurrence or metastasis between patients with LLN+ versus LLN- and in patients with LLN ≥7 versus <7 mm on baseline MRI. LLN dissection was performed in 3 patients; 2 of them died of distant metastasis. Conclusions: LLN involvement is not associated with disease recurrence or metastasis, but persistence of LLN ≥4 mm after TNT is negatively associated with rectum preservation in patients with locally advanced rectal cancer treated with TNT. Dissection of lateral nodes likely benefits few patients. © 2024 Wolters Kluwer Health, Inc. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; clinical trial; histopathology; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; lymph node metastasis; lymph node dissection; pelvis lymph node; lymph nodes; lymphatic metastasis; neoplasm staging; pelvis; lymph node excision; adenocarcinoma; phase 2 clinical trial; neoplasm recurrence, local; randomized controlled trial; pathology; diagnostic imaging; distant metastasis; sex ratio; correlation analysis; conservative treatment; multicenter study; tumor recurrence; lymph node; recurrent disease; organ preservation; rectal neoplasms; rectum tumor; ethnicity; therapy; race; rectal cancer; total mesorectal excision; post hoc analysis; rectal adenocarcinoma; interrater reliability; consolidation chemotherapy; organ sparing treatments; humans; human; male; female; article; total neoadjuvant therapy; metastasis site |
| Journal Title: | Annals of Surgery |
| Volume: | 282 |
| Issue: | 2 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2025-08-01 |
| Start Page: | 311 |
| End Page: | 318 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000006305 |
| PUBMED: | 38647132 |
| PROVIDER: | scopus |
| PMCID: | PMC11686994 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Julio Garcia-Aguilar -- Source: Scopus |
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