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Erschienen in: Diseases of the Colon & Rectum 3/2008

01.03.2008 | Original Contribution

Absence of Lymph Nodes in the Resected Specimen After Radical Surgery for Distal Rectal Cancer and Neoadjuvant Chemoradiation Therapy: What does it Mean?

verfasst von: Angelita Habr-Gama, M.D., Ph.D., Rodrigo O. Perez, M.D., Ph.D., Igor Proscurshim, M.S., Viviane Rawet, M.D., Ph.D., Diego D. Pereira, M.S., Afonso H. S. Sousa, M.D., Ph.D., Desiderio Kiss, M.D., Ph.D., Ivan Cecconello, M.D., Ph.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 3/2008

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Abstract

Purpose

The number of retrieved lymph nodes during radical surgery has been considered of great importance to ensure adequate staging and radical resection. However, this finding may not be applicable after neoadjuvant therapy in which, not only is there a decrease in lymph nodes recovered, but also a subgroup of patients with absence of lymph nodes in the resected specimen.

Methods

Patients with absence of lymph nodes were compared with patients with ypN0 disease and patients with ypN+ disease.

Results

Thirty-two patients (11 percent) had absence of lymph nodes, 171 patients (61 percent) had ypN0 disease, and 78 patients (28 percent) had ypN+ disease. Patients with absence of lymph nodes had significantly lower ypT status (ypT0-1, 40 vs. 13 percent; P < 0.001) and decreased risk of perineural invasion (6 vs. 21 percent; P = 0.04) compared with ypN0 patients. Five-year disease-free survival (74 percent) was similar to patients with ypN0 (59 percent; P = 0.2), and both were significantly better than patients with ypN+ disease (30 percent; P < 0.001).

Conclusions

Absence of lymph nodes retrieved from the resected specimen is associated with favorable pathologic features (ypT and perineural invasion status) and good disease-free survival rates. In this setting, absence of retrieved lymph nodes may reflect improved response to neoadjuvant chemoradiation therapy rather than inappropriate or suboptimal oncologic radicality.
Literatur
1.
Zurück zum Zitat Tepper JE, O'Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001;19:157–63.PubMed Tepper JE, O'Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001;19:157–63.PubMed
2.
Zurück zum Zitat Sobin LH, Greene FL. TNM classification: clarification of number of regional lymph nodes for pNo. Cancer 2001;92:452.PubMedCrossRef Sobin LH, Greene FL. TNM classification: clarification of number of regional lymph nodes for pNo. Cancer 2001;92:452.PubMedCrossRef
3.
Zurück zum Zitat Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003;10:65–71.PubMedCrossRef Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003;10:65–71.PubMedCrossRef
4.
Zurück zum Zitat Prandi M, Lionetto R, Bini A, et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 2002;235:458–63.PubMedCrossRef Prandi M, Lionetto R, Bini A, et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 2002;235:458–63.PubMedCrossRef
5.
Zurück zum Zitat Pocard M, Panis Y, Malassagne B, Nemeth J, Hautefeuille P, Valleur P. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum 1998;41:839–45.PubMedCrossRef Pocard M, Panis Y, Malassagne B, Nemeth J, Hautefeuille P, Valleur P. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum 1998;41:839–45.PubMedCrossRef
6.
Zurück zum Zitat Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRef Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRef
7.
Zurück zum Zitat Habr-Gama A, Perez RO, Kiss DR, et al. Preoperative chemoradiation therapy for low rectal cancer. Impact on downstaging and sphincter-saving operations. Hepatogastroenterology 2004;51:1703–7.PubMed Habr-Gama A, Perez RO, Kiss DR, et al. Preoperative chemoradiation therapy for low rectal cancer. Impact on downstaging and sphincter-saving operations. Hepatogastroenterology 2004;51:1703–7.PubMed
8.
Zurück zum Zitat Perez RO, Habr-Gama A, Nishida Arazawa ST, et al. Lymph node micrometastasis in stage II distal rectal cancer following neoadjuvant chemoradiation therapy. Int J Colorectal Dis 2005;20:434–9.PubMedCrossRef Perez RO, Habr-Gama A, Nishida Arazawa ST, et al. Lymph node micrometastasis in stage II distal rectal cancer following neoadjuvant chemoradiation therapy. Int J Colorectal Dis 2005;20:434–9.PubMedCrossRef
9.
Zurück zum Zitat Wijesuriya RE, Deen KI, Hewavisenthi J, Balawardana J, Perera M. Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly. Surg Today 2005;35:442–5.PubMedCrossRef Wijesuriya RE, Deen KI, Hewavisenthi J, Balawardana J, Perera M. Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly. Surg Today 2005;35:442–5.PubMedCrossRef
10.
Zurück zum Zitat Baxter NN, Morris AM, Rothenberger DA, Tepper JE. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys 2005;61:426–31.PubMed Baxter NN, Morris AM, Rothenberger DA, Tepper JE. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys 2005;61:426–31.PubMed
11.
Zurück zum Zitat Habr-Gama A, de Souza PM, Ribeiro U Jr, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 1998;41:1087–96.PubMedCrossRef Habr-Gama A, de Souza PM, Ribeiro U Jr, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 1998;41:1087–96.PubMedCrossRef
12.
Zurück zum Zitat Habr-Gama A. Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy. Colorectal Dis 2006;8(Suppl 3):21–4.PubMedCrossRef Habr-Gama A. Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy. Colorectal Dis 2006;8(Suppl 3):21–4.PubMedCrossRef
13.
Zurück zum Zitat Habr-Gama A, Perez RO, Proscurshim I, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 2006;10:1319–29.PubMedCrossRef Habr-Gama A, Perez RO, Proscurshim I, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 2006;10:1319–29.PubMedCrossRef
14.
Zurück zum Zitat Greene FL, American Joint Committee on Cancer, American Cancer Society. AJCC cancer staging manual, 6th ed. New York: Springer, 2002. Greene FL, American Joint Committee on Cancer, American Cancer Society. AJCC cancer staging manual, 6th ed. New York: Springer, 2002.
15.
Zurück zum Zitat Tepper JE. Adjuvant radiation therapy of rectal cancer. J Clin Oncol 2001;19:3709–11.PubMed Tepper JE. Adjuvant radiation therapy of rectal cancer. J Clin Oncol 2001;19:3709–11.PubMed
16.
Zurück zum Zitat Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 1999;17:2896–900.PubMed Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 1999;17:2896–900.PubMed
17.
Zurück zum Zitat Goldstein NS, Sanford W, Coffey M, Layfield LJ. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 1996;106:209–16.PubMed Goldstein NS, Sanford W, Coffey M, Layfield LJ. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 1996;106:209–16.PubMed
18.
Zurück zum Zitat Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165–7.PubMedCrossRef Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165–7.PubMedCrossRef
19.
Zurück zum Zitat Greco P, Andreola S, Magro G, et al. Potential pathological understaging of pT3 rectal cancer with less than 26 lymph nodes recovered: a prospective study based on a resampling of 50 rectal specimens. Virchows Arch 2006;449:647–51.PubMedCrossRef Greco P, Andreola S, Magro G, et al. Potential pathological understaging of pT3 rectal cancer with less than 26 lymph nodes recovered: a prospective study based on a resampling of 50 rectal specimens. Virchows Arch 2006;449:647–51.PubMedCrossRef
20.
Zurück zum Zitat Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 2002;26:179–89.PubMedCrossRef Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 2002;26:179–89.PubMedCrossRef
21.
Zurück zum Zitat Gorog D, Nagy P, Peter A, Perner F. Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res 2003;9:180–3.PubMedCrossRef Gorog D, Nagy P, Peter A, Perner F. Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res 2003;9:180–3.PubMedCrossRef
22.
Zurück zum Zitat Wichmann MW, Muller C, Meyer G, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 2002;137:206–10.PubMedCrossRef Wichmann MW, Muller C, Meyer G, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 2002;137:206–10.PubMedCrossRef
23.
Zurück zum Zitat Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97:219–25.PubMedCrossRef Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97:219–25.PubMedCrossRef
24.
Zurück zum Zitat Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.PubMedCrossRef Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.PubMedCrossRef
25.
Zurück zum Zitat Fajardo LF. Lymph nodes and cancer. A review. Front Radiat Ther Oncol 1994;28:1–10.PubMed Fajardo LF. Lymph nodes and cancer. A review. Front Radiat Ther Oncol 1994;28:1–10.PubMed
26.
Zurück zum Zitat Sermier A, Gervaz P, Egger JF, et al. Lymph node retrieval in abdominoperineal surgical specimen is radiation time-dependent. World J Surg Oncol 2006;4:29.PubMedCrossRef Sermier A, Gervaz P, Egger JF, et al. Lymph node retrieval in abdominoperineal surgical specimen is radiation time-dependent. World J Surg Oncol 2006;4:29.PubMedCrossRef
27.
Zurück zum Zitat Luna-Perez P, Rodriguez-Ramirez S, Alvarado I, Gutierrez de la Barrera M, Labastida S. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res 2003;34:281–6.PubMedCrossRef Luna-Perez P, Rodriguez-Ramirez S, Alvarado I, Gutierrez de la Barrera M, Labastida S. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res 2003;34:281–6.PubMedCrossRef
28.
Zurück zum Zitat Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005;61:665–77.PubMed Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005;61:665–77.PubMed
29.
Zurück zum Zitat Habr-Gama A, Perez RO, Nadalin W, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg 2005;9:90–101.PubMedCrossRef Habr-Gama A, Perez RO, Nadalin W, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg 2005;9:90–101.PubMedCrossRef
Metadaten
Titel
Absence of Lymph Nodes in the Resected Specimen After Radical Surgery for Distal Rectal Cancer and Neoadjuvant Chemoradiation Therapy: What does it Mean?
verfasst von
Angelita Habr-Gama, M.D., Ph.D.
Rodrigo O. Perez, M.D., Ph.D.
Igor Proscurshim, M.S.
Viviane Rawet, M.D., Ph.D.
Diego D. Pereira, M.S.
Afonso H. S. Sousa, M.D., Ph.D.
Desiderio Kiss, M.D., Ph.D.
Ivan Cecconello, M.D., Ph.D.
Publikationsdatum
01.03.2008
Verlag
Springer-Verlag
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 3/2008
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-9148-5

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