Work

Lateral pelvic lymph node dissection based on nodal response to neoadjuvant chemoradiotherapy in mid/low rectal cancer: a retrospective comparative cohort study

Year: 2025

Type: article

Abstract: Purpose: Total mesorectal excision (TME) without lateral pelvic lymph node (LPN) dissection (LPND) is feasible in patients with mid/low rectal cancer showing a reduction in LPN size to ≤5 mm following neoadjuvant chemoradiotherapy (nCRT).We aimed to evaluate the clinical outcomes of selective LPNDs based on these criteria.Methods: Patients with mid/low rectal cancer and LPNs >5 mm before nCRT were included and classified based on nCRT response (post-nCRT LPN size ≤5 mm [responsive] vs. >5 mm [persistent]) and surgical procedure (TME alone vs. TME + LPND).In the responsive group, LPND was selectively performed only if morphologic predictors of LPN metastasis were present.Clinical outcomes were analyzed across subgroups.Results: Of 122 patients, 82 were in the responsive group.Within this group, 61 underwent TME alone and 21 underwent TME + LPND.No locoregional recurrence was observed in either subgroup of the responsive group, with similar systemic metastasis rates (13.1% vs. 14.3%,P > 0.99).The TME alone subgroup showed significantly smaller post-nCRT LPN sizes (1.7 ± 2.1 mm vs. 3.9 ± 1.8 mm, P < 0.001) and lower ycN positivity rates (31.1% vs. 71.4%,P = 0.001).Conclusion: Selective LPND based on post-nCRT LPN size ≤5 mm and the absence of morphologic predictors of metastasis may serve as a feasible option for managing mid/low rectal cancer with enlarged LPNs, thereby optimizing local control and reducing unnecessary surgeries.

Source: Annals of Surgical Treatment and Research

DOI: 10.4174/astr.2025.108.6.333