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. 2023 Sep;30(9):5472-5485.
doi: 10.1245/s10434-023-13460-0. Epub 2023 Jun 20.

Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

Tania C Sluckin  1   2   3 , Sanne-Marije J A Hazen  1   2   3 , Karin Horsthuis  3   4 , Regina G H Beets-Tan  5   6   7   8 , Arend G J Aalbers  9 , Geerard L Beets  6   9 , Evert-Jan G Boerma  10 , Jaap Borstlap  11 , Vivian van Breest Smallenburg  12 , Jacobus W A Burger  13 , Rogier M P H Crolla  14 , Alette W Daniëls-Gooszen  15 , Paul H P Davids  16 , Michalda S Dunker  17 , Hans F J Fabry  18 , Edgar J B Furnée  19 , Renza A H van Gils  20 , Robbert J de Haas  21 , Stefan Hoogendoorn  22 , Sebastiaan van Koeverden  23 , Fleur I de Korte  24 , Steven J Oosterling  25 , Koen C M J Peeters  26 , Lisanne A E Posma  27 , Bareld B Pultrum  28 , Joost Rothbarth  29 , Harm J T Rutten  6   13 , Renske A Schasfoort  30 , Wilhelmina H Schreurs  17 , Petra C G Simons  31 , Anke B Smits  32 , Aaldert K Talsma  33 , G Y Mireille The  34 , Fiek van Tilborg  35 , Jurriaan B Tuynman  1   2   3 , Inge J S Vanhooymissen  4 , Anthony W H van de Ven  36 , Emiel G G Verdaasdonk  37 , Maarten Vermaas  38 , Roy F A Vliegen  39 , F Jeroen Vogelaar  40 , Marianne de Vries  20 , Joy C Vroemen  41 , Sebastiaan T van Vugt  42 , Marinke Westerterp  43 , Henderik L van Westreenen  44 , Johannes H W de Wilt  45 , Edwin S van der Zaag  46 , David D E Zimmerman  47 , Corrie A M Marijnen  48   49 , Pieter J Tanis  2   3   29   50 , Miranda Kusters  51   52   53 ; Dutch Snapshot Research Group
Collaborators, Affiliations

Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

Tania C Sluckin et al. Ann Surg Oncol. 2023 Sep.

Abstract

Background: Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level.

Methods: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either 'node-picking' (the removal of an individual LLN) or 'partial regional node dissection' (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection.

Results: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7-3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2-2.5, p = 0.874).

Conclusion: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.

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Figures

Fig. 1
Fig. 1
Selection process of included patients. LLN lateral lymph node, LLND LLN dissection, TME total mesorectal excision
See this image and copyright information in PMC

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