Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: Rationale for radical resection? Journal Article

  


Authors: Stipa, F.; Zernecke, A.; Moore, H. G.; Minsky, B. D.; Wong, W. D.; Weiser, M.; Paty, P. B.; Shia, J.; Guillem, J. G.
Article Title: Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: Rationale for radical resection?
Abstract: Background: In order to evaluate the impact of preoperative radiation and chemotherapy (combined modality therapy, or CMT) on primary rectal cancer and mesorectal lymph nodes (MLNs), middle and lower third rectal cancers were resected with total mesorectal excision (TME) and assessed for frequency of MLN retrieval and residual MLN involvement. Methods: Between 1990 and 2001, 187 consecutive patients underwent abdominoperineal resection (APR) or low anterior resection (LAR) for locally advanced (endorectal ultrasound [ERUS] stage, T 3-4) mid and distal rectal cancer following preoperative CMT. Sphincter preservation was possible in 150 patients (80%). The mean number of retrieved MLNs was 10.6. Pre-CMT ERUS stage was compared with final pathologic stage. Results: Comparison of pre-CMT ERUS stage with pathologic stage revealed a decrease in T stage in 93 patients (49%), as well as a decrease in the percentage of individuals with positive MLNs, from 54% to 27% (P < .0001). The overall incidence of positive MLN involvement was 27%, and incidence paralleled pathologic T stage (pT): pT0 = 7%, pT1 = 8%, pT2 = 22%, pT3 = 37%, and pT4 = 67%. Conclusions: Following preoperative CMT, the incidence of residual MLN involvement remains significant and parallels increasing pT stage. Therefore, the standard of care for locally advanced distal rectal cancer should continue to include formal rectal resection (TME). © 2004 The Society of Surgical Oncology, Inc.
Keywords: adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; major clinical study; histopathology; fluorouracil; advanced cancer; united states; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; preoperative care; neoadjuvant therapy; cancer staging; lymph node metastasis; staging; lymphatic metastasis; radiotherapy; incidence; pathology; retrospective study; ultrasound; minimal residual disease; neoplasm, residual; folinic acid; new york city; rectal neoplasms; rectum cancer; rectum tumor; rectal cancer; rectum abdominoperineal resection; anus sphincter; mesorectal lymph nodes; humans; human; male; female; article
Journal Title: Annals of Surgical Oncology
Volume: 11
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2004-02-01
Start Page: 187
End Page: 191
Language: English
DOI: 10.1245/aso.2004.06.010
PROVIDER: scopus
PUBMED: 14761922
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-2342537777&partnerID=40&md5=810d2061a8e44e4ea20ab808335f5a65
Notes: Ann. Surg. Oncol. -- Cited By (since 1996):43 -- Export Date: 16 June 2014 -- CODEN: ASONF -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Harvey Moore
    31 Moore
  2. Francesco Stipa
    5 Stipa
  3. Philip B Paty
    500 Paty
  4. Bruce Minsky
    306 Minsky
  5. Jose Guillem
    414 Guillem
  6. Jinru Shia
    720 Shia
  7. Martin R Weiser
    539 Weiser
  8. Douglas W Wong
    178 Wong
Related MSK Work