Preoperative lateral lymph node features and impact on local recurrence after neoadjuvant chemoradiotherapy and total mesorectal excision for locally advanced rectal cancer: results from a multicentre international cohort study
Pietro Achilli
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Conceptualization, Investigation, Formal analysis, Writing - original draft, Methodology, Validation, Writing - review & editing
Search for more papers by this authorDavide Ferrari
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Formal analysis, Writing - original draft, Data curation, Methodology, Writing - review & editing
Search for more papers by this authorGiacomo Calini
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Conceptualization, Formal analysis, Writing - original draft, Validation, Visualization, Writing - review & editing
Search for more papers by this authorCamillo L. Bertoglio
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Validation, Writing - review & editing
Search for more papers by this authorCarmelo Magistro
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Methodology, Writing - review & editing
Search for more papers by this authorMatteo Origi
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Formal analysis, Writing - review & editing, Visualization
Search for more papers by this authorPietro Carnevali
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Formal analysis, Data curation, Writing - review & editing
Search for more papers by this authorBruno D. Alampi
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorIrene Giusti
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorGiovanni Ferrari
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Methodology, Conceptualization, Project administration, Writing - original draft, Supervision, Writing - review & editing
Search for more papers by this authorEleonora Calafiore
Department of Biomedical Sciences, Humanitas University, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorAntonino Spinelli
Department of Biomedical Sciences, Humanitas University, Milan, Italy
IRCCS Humanitas Research Hospital, Milan, Italy
Contribution: Conceptualization, Methodology, Writing - original draft, Writing - review & editing, Supervision
Search for more papers by this authorFabian Grass
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Investigation, Data curation, Visualization, Writing - review & editing, Writing - original draft
Search for more papers by this authorPhilip Deslarzes
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorDieter Hahnloser
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Conceptualization, Methodology, Project administration, Supervision, Writing - review & editing
Search for more papers by this authorSolafah Abdalla
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorCorresponding Author
David W. Larson
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Correspondence
David W. Larson, Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN 55905, USA.
Email: [email protected]
Contribution: Conceptualization, Methodology, Investigation, Project administration, Writing - original draft, Validation, Supervision, Visualization, Writing - review & editing
Search for more papers by this authorPietro Achilli
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Conceptualization, Investigation, Formal analysis, Writing - original draft, Methodology, Validation, Writing - review & editing
Search for more papers by this authorDavide Ferrari
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Formal analysis, Writing - original draft, Data curation, Methodology, Writing - review & editing
Search for more papers by this authorGiacomo Calini
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Conceptualization, Formal analysis, Writing - original draft, Validation, Visualization, Writing - review & editing
Search for more papers by this authorCamillo L. Bertoglio
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Validation, Writing - review & editing
Search for more papers by this authorCarmelo Magistro
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Methodology, Writing - review & editing
Search for more papers by this authorMatteo Origi
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Formal analysis, Writing - review & editing, Visualization
Search for more papers by this authorPietro Carnevali
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Formal analysis, Data curation, Writing - review & editing
Search for more papers by this authorBruno D. Alampi
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorIrene Giusti
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorGiovanni Ferrari
Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
Contribution: Methodology, Conceptualization, Project administration, Writing - original draft, Supervision, Writing - review & editing
Search for more papers by this authorEleonora Calafiore
Department of Biomedical Sciences, Humanitas University, Milan, Italy
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorAntonino Spinelli
Department of Biomedical Sciences, Humanitas University, Milan, Italy
IRCCS Humanitas Research Hospital, Milan, Italy
Contribution: Conceptualization, Methodology, Writing - original draft, Writing - review & editing, Supervision
Search for more papers by this authorFabian Grass
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Investigation, Data curation, Visualization, Writing - review & editing, Writing - original draft
Search for more papers by this authorPhilip Deslarzes
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorDieter Hahnloser
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
Contribution: Conceptualization, Methodology, Project administration, Supervision, Writing - review & editing
Search for more papers by this authorSolafah Abdalla
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorCorresponding Author
David W. Larson
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
Correspondence
David W. Larson, Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN 55905, USA.
Email: [email protected]
Contribution: Conceptualization, Methodology, Investigation, Project administration, Writing - original draft, Validation, Supervision, Visualization, Writing - review & editing
Search for more papers by this authorDavide Ferrari and Giacomo Calini contributed equally to this work.
Abstract
Aim
Locally advanced rectal cancer (LARC) is commonly treated with neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) to reduce local recurrence (LR) and improve survival. However, LR, particularly associated with lateral lymph node (LLN) involvement, remains a concern. The aim of this study was to investigate preoperative factors associated with LLN involvement and their impact on LR rates in LARC patients undergoing nCRT and curative surgery.
Method
This multicentre retrospective study, including four academic high-volume institutions, involved 301 consecutive adult LARC patients treated with nCRT and curative surgery between January 2014 and December 2019 who did not undergo lateral lymph node dissection (LLND). Baseline and restaging pelvic MRIs were evaluated for suspicious LLNs based on institutional criteria. Patients were divided into two groups: cLLN+ (positive nodes) and cLLN– (no suspicious nodes). Primary outcome measures were LR and lateral local recurrence (LLR) rates at 3 years.
Results
Among the cohort, 15.9% had suspicious LLNs on baseline MRI, and 9.3% had abnormal LLNs on restaging MRI. At 3 years, LR and LLR rates were 4.0% and 1.0%, respectively. Ten out of 12 (83.3%) patients with LR showed no suspicious LLNs at the baseline MRI. Abnormal LLNs on MRI were not independent risk factors for LR, distant recurrence or disease-free survival.
Conclusion
Abnormal LLNs on baseline and restaging MRI assessment did not impact LR and LLR rates in this cohort of patients with LARC submitted to nCRT and curative TME surgery.
CONFLICT OF INTEREST STATEMENT
Antonino Spinelli received speaker fees from Johnson&Johnson and Takeda. The other authors declare no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
Data supporting the research are available upon request to protect the privacy of study participants.
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