Lateral pelvic lymph node dissection based on nodal response to neoadjuvant chemoradiotherapy in mid/low rectal cancer: a retrospective comparative cohort study
10.4174/astr.2025.108.6.333
- Author:
Tae-Gyun LEE
1
;
Duck-Woo KIM
;
Hong-min AHN
;
Hye-Rim SHIN
;
Mi Jeong CHOI
;
Min Hyeong JO
;
Heung-Kwon OH
;
Sung-Bum KANG
Author Information
1. Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Publication Type:ORIGINAL ARTICLE
- From:Annals of Surgical Treatment and Research
2025;108(6):333-344
- CountryRepublic of Korea
- Language:English
-
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.
