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Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications
Author(s) -
Zhou Sicheng,
Jiang Yujuan,
Pei Wei,
Zhou Haitao,
Liang Jianwei,
Zhou Zhixiang
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26509
Subject(s) - medicine , dissection (medical) , colorectal cancer , odds ratio , adenocarcinoma , neoadjuvant therapy , lymph node , pathological , chemoradiotherapy , retrospective cohort study , total mesorectal excision , confidence interval , surgery , radiology , cancer , breast cancer
Background and Objectives There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT). Methods We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group ( n = 73) and non‐nCRT group ( n = 78). Results Thirty‐one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03–43.03, p = 0.047) and post‐nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87–247.91, p = 0.004) were independent risk factors for pathological LPNM. Conclusion nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post‐nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.