Optimal diagnostic criteria for lateral lymph node dissection using magnetic resonance imaging: a multicenter prospective study.
MRI
criteria
lateral lymph node metastasis
rectal cancer
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
23
08
2022
received:
25
06
2022
accepted:
24
08
2022
pubmed:
8
9
2022
medline:
22
2
2023
entrez:
7
9
2022
Statut:
ppublish
Résumé
LLND in cases with suspected lateral lymph node (LLN) metastasis has been focused on as a novel treatment strategy in recent years. However, the optimal indication for LLND in rectal cancer patients has not been determined. This study aimed to establish the optimal indication for lateral lymph node dissection (LLND) in patients with rectal cancer using magnetic resonance imaging (MRI). A total of 209 patients with rectal adenocarcinoma who underwent total mesorectal excision and LLND in 13 hospitals were prospectively registered. By matching the sizes of the harvested LNs and those in magnetic resonance imaging (MRI), the pathological outcome of each LN was confirmed one-by-one. Using parameters of the LLNs in MRI, the optimal diagnostic criteria for LLND were established. Of 3241 harvested LLNs, including 83 metastatic nodes, 1010 (31.1%) were visualized on MRI. Although all parameters assessed showed strong correlations with the presence of metastasis, none of these parameters could discriminate metastatic LLNs from non-metastatic nodes with sufficient sensitivity. However, by using the combination of long axis and short/long ratio in pretreatment MRI, we could establish optimal criteria for LLND. The sensitivity and specificity of the criteria for LLN metastasis were 94.3% and 40.2%, respectively. In conclusion, we established novel criteria for LLND in rectal cancer patients using MRI. Our criteria will be of great clinical use in determining indications for LLND.
Sections du résumé
BACKGROUND
LLND in cases with suspected lateral lymph node (LLN) metastasis has been focused on as a novel treatment strategy in recent years. However, the optimal indication for LLND in rectal cancer patients has not been determined. This study aimed to establish the optimal indication for lateral lymph node dissection (LLND) in patients with rectal cancer using magnetic resonance imaging (MRI).
METHODS
A total of 209 patients with rectal adenocarcinoma who underwent total mesorectal excision and LLND in 13 hospitals were prospectively registered. By matching the sizes of the harvested LNs and those in magnetic resonance imaging (MRI), the pathological outcome of each LN was confirmed one-by-one. Using parameters of the LLNs in MRI, the optimal diagnostic criteria for LLND were established.
RESULTS
Of 3241 harvested LLNs, including 83 metastatic nodes, 1010 (31.1%) were visualized on MRI. Although all parameters assessed showed strong correlations with the presence of metastasis, none of these parameters could discriminate metastatic LLNs from non-metastatic nodes with sufficient sensitivity. However, by using the combination of long axis and short/long ratio in pretreatment MRI, we could establish optimal criteria for LLND. The sensitivity and specificity of the criteria for LLN metastasis were 94.3% and 40.2%, respectively.
CONCLUSIONS
In conclusion, we established novel criteria for LLND in rectal cancer patients using MRI. Our criteria will be of great clinical use in determining indications for LLND.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
206-213Subventions
Organisme : Japanese Society for Cancer of the Colon and Rectum
Informations de copyright
© 2022 Royal Australasian College of Surgeons.
Références
Smith JJ, Garcia-Aguilar J. Advances and challenges in treatment of locally advanced rectal cancer. J. Clin. Oncol. 2015; 33: 1797-808.
Kusters M, Beets GL, van de Velde CJ, Beets-Tan RG, Marijnen CA et al. A comparison between the treatment of low rectal cancer in Japan and The Netherlands, focusing on the patterns of local recurrence. Ann. Surg. 2009; 249: 229-35.
Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int. J. Clin. Oncol. 2018; 23: 1-34.
Kim TH, Jeong SY, Choi DH et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann. Surg. Oncol. 2008; 15: 729-37.
Ogura A, Konishi T, Cunningham C et al. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J. Clin. Oncol. 2019; 37: 33-43.
Otero de Pablos J, Mayol J. Controversies in the management of lateral pelvic lymph nodes in patients with advanced rectal cancer: east or west? Front. Surg. 2019; 6: 79.
Brown G, Richards CJ, Bourne MW et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003; 227: 371-7.
Yamaoka Y, Kinugasa Y, Shiomi A et al. Preoperative chemoradiotherapy changes the size criterion for predicting lateral lymph node metastasis in lower rectal cancer. Int. J. Colorectal Dis. 2017; 32: 1631-7.
Malakorn S, Yang Y, Bednarski BK et al. Who should get lateral pelvic lymph node dissection after neoadjuvant chemoradiation? Dis. Colon Rectum 2019; 62: 1158-66.
Akiyoshi T, Matsueda K, Hiratsuka M, Unno T, Nagata J et al. Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative chemoradiotherapy in patients with advanced low-rectal cancer. Ann. Surg. Oncol. 2015; 22: S614-20.
Ishihara S, Kawai K, Tanaka T et al. Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy. Dis. Colon Rectum 2017; 60: 469-76.
Ogawa S, Hida J, Ike H et al. Selection of lymph node-positive cases based on perirectal and lateral pelvic lymph nodes using magnetic resonance imaging: study of the Japanese Society for Cancer of the Colon and Rectum. Ann. Surg. Oncol. 2016; 23: 1187-94.
Hoshino N, Murakami K, Hida K, Sakamoto T. Sakai Y diagnostic accuracy of magnetic resonance imaging and computed tomography for lateral lymph node metastasis in rectal cancer: a systematic review and meta-analysis. Int. J. Clin. Oncol. 2019; 24: 46-52.
Ogawa S, Hida JI, Ike H et al. Prediction of lateral pelvic lymph node metastasis from lower rectal cancer using magnetic resonance imaging and risk factors for metastasis: multicenter study of the Lymph Node Committee of the Japanese Society for Cancer of the Colon and Rectum. Int. J. Colorectal Dis. 2017; 32: 1479-87.
Taylor FG, Quirke P, Heald RJ et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J. Clin. Oncol. 2014; 32: 34-43.
Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d English Edition [secondary publication]. J. Anus Rectum Colon 2019; 3: 175-95.
Akasu T, Sugihara K, Moriya Y. Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann. Surg. Oncol. 2009; 16: 2779-86.
Kyo K, Sameshima S, Takahashi M, Furugori T, Sawada T. Impact of autonomic nerve preservation and lateral node dissection on male urogenital function after total mesorectal excision for lower rectal cancer. World J. Surg. 2006; 30: 1014-9.
Ito M, Kobayashi A, Fujita S et al. Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur. J. Surg. Oncol. 2018; 44: 463-8.
Saito S, Fujita S, Mizusawa J et al. Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur. J. Surg. Oncol. 2016; 42: 1851-8.
Hashiguchi Y, Muro K, Saito Y et al. Japanese Society for Cancer of the colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int. J. Clin. Oncol. 2020; 25: 1-42.
Kobayashi H, Mochizuki H, Kato T et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis. Colon Rectum 2009; 52: 567-76.
Gröne J, Loch FN, Taupitz M, Schmidt C. Kreis ME accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J. Gastrointest. Surg. 2018; 22: 146-53.
Doyon F, Attenberger UI, Dinter DJ, Schoenberg SO, Post S, Kienle P. Clinical relevance of morphologic MRI criteria for the assessment of lymph nodes in patients with rectal cancer. Int. J. Colorectal Dis. 2015; 30: 1541-6.
Perez RO, Sao Juliao GP, Vailati BB, Fernandez LM, Mattacheo AE et al. Lateral node dissection in rectal cancer in the era of minimally invasive surgery: a step-by-step description for the surgeon unacquainted with this complex procedure with the use of the laparoscopic approach. Dis. Colon Rectum 2018; 61: 1237-40.