Effect of Lateral Lymph Nodes Without Malignant Characteristics on the Prognosis of Patients with Rectal Cancer

Abstract

Background:

Lateral lymph node (LLN) metastasis is a poor prognostic factor for rectal cancer patients. However, the effect of LLNs without malignant characteristics on the prognosis of rectal cancer patients has been uncertain.

Methods:

Consecutive patients who underwent laparoscopic-assisted low anterior resection were included. Patients with MRI-detected LLNs, but without malignant characteristics, were compared with patients with no MRI-detected LLNs.

Results:

The local recurrence rate was higher in the LLN-present group than in the LLN-absent group (9.8% vs 2.5%; p = 0.056). The overall survival of patients with no MRI-detected LLNs was significantly better than that of patients with MRI-detected LLNs (p = 0.021).

Conclusion:

The presence of LLNs, even without malignant features, may lead to worse local control and overall survival.

Plain language summary

Lymph node metastasis in the pelvic sidewall of patients with rectal cancer is a serious disease that affects the patient’s life expectancy. At present, the assessment of lateral lymph node (LLN) metastasis relies mainly on MRI. Currently, there is no consensus on whether small lymph nodes without malignant features detected by MRI affect patient prognosis. Therefore, the authors designed this study to compare the survival of patients with small LLNs detected by MRI with that of patients without LLNs. The authors found that the presence of LLNs, even without malignant features, may lead to worse local control and overall survival. Therefore, for patients with MRI-detected LLNs, LLN dissection should be conducted by experienced surgeons to improve patient prognosis.

Keywords::

• lateral lymph node
• MRI
• oncologic outcomes
• preoperative chemoradiotherapy
• rectal cancer

Author contributions

Conception and design: CH Zhang, XQ Su; data collection: MX Liu, K Xu, F Tan; analysis and interpretation of data: CH Zhang, M Cui, H Yang; writing – original draft: CH Zhang; data curation and review of the manuscript: JD Xing, ZD Yao; study supervision: M Cui, N Zhang, ZD Yao. All authors have read and approved the final version of the manuscript.

Financial & competing interests disclosure

This work was supported by the National Natural Science Foundation of China (nos. 81872022, 81672439), Beijing Natural Science Foundation (no. 7162039) and Capital’s Funds for Health Improvement and Research (CFH 2018-2-2153). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (nos. 81872022, 81672439), Beijing Natural Science Foundation (no. 7162039) and Capital’s Funds for Health Improvement and Research (CFH 2018-2-2153). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.