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Ann Surg Oncol Early Release, published online ahead of print Jan 12 2004
Annals of Surgical Oncology, 10.1245/ASO.2004.06.010
 © 2004 Society of Surgical Oncology
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Original Articles

Residual Mesorectal Lymph Node Involvement Following Neoadjuvant Combined-Modality Therapy: Rationale for Radical Resection?

Francesco Stipa, MD, Alma Zernecke, MD, Harvey G. Moore, MD, Bruce D. Minsky, MD, W. Douglas Wong, MD, Martin Weiser, MD, Philip B. Paty, MD, Jinru Shia, MD, Jose G. Guillem, MD, MPH

From the Colorectal Service, Department of Surgery (FS, AZ, HGM, WDW, MW, PBP, JGG), Department of Radiation Oncology (BDM), and Department of Pathology (JS), Memorial Sloan-Kettering Cancer Center, New York, New York.

Address correspondence and reprint requests to: Jose G. Guillem, MD, MPH, 1275 York Avenue, Room C-1077, New York, NY 10021; Fax: 646-422-2318.


  Abstract

Background: In order to evaluate the impact of preoperative radiation and chemotherapy (combined modality therapy, or CMT) on primary rectal cancer and mesorectal lymph nodes (MLNs), middle and lower third rectal cancers were resected with total mesorectal excision (TME) and assessed for frequency of MLN retrieval and residual MLN involvement.

Methods: Between 1990 and 2001, 187 consecutive patients underwent abdominoperineal resection (APR) or low anterior resection (LAR) for locally advanced (endorectal ultrasound [ERUS] stage, T3-4) mid and distal rectal cancer following preoperative CMT. Sphincter preservation was possible in 150 patients (80%). The mean number of retrieved MLNs was 10.6. Pre-CMT ERUS stage was compared with final pathologic stage.

Results: Comparison of pre-CMT ERUS stage with pathologic stage revealed a decrease in T stage in 93 patients (49%), as well as a decrease in the percentage of individuals with positive MLNs, from 54% to 27% (P < .0001). The overall incidence of positive MLN involvement was 27%, and incidence paralleled pathologic T stage (pT): pT0 = 7%, pT1 = 8%, pT2 = 22%, pT3 = 37%, and pT4 = 67%.

Conclusions: Following preoperative CMT, the incidence of residual MLN involvement remains significant and parallels increasing pT stage. Therefore, the standard of care for locally advanced distal rectal cancer should continue to include formal rectal resection (TME).

Key Words: Mesorectal lymph nodes, Radiotherapy, Rectal cancer, Staging.




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J. G. Guillem, D. B. Chessin, J. Shia, H. G. Moore, M. Mazumdar, B. Bernard, P. B. Paty, L. Saltz, B. D. Minsky, M. R. Weiser, et al.
Clinical Examination Following Preoperative Chemoradiation for Rectal Cancer Is Not a Reliable Surrogate End Point
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