TY - JOUR
T1 - Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting
AU - Sluckin, Tania C.
AU - Hazen, Sanne-Marije J. A.
AU - Horsthuis, Karin
AU - Beets-Tan, Regina G. H.
AU - Aalbers, Arend G. J.
AU - Beets, Geerard L.
AU - Boerma, Evert-Jan G.
AU - Borstlap, Jaap
AU - Smallenburg, Vivian van Breest
AU - Burger, Jacobus W. A.
AU - Crolla, Rogier M. P. H.
AU - Daniels-Gooszen, Alette W.
AU - Davids, Paul H. P.
AU - Dunker, Michalda S.
AU - Fabry, Hans F. J.
AU - Furnee, Edgar J. B.
AU - van Gils, Renza A. H.
AU - de Haas, Robbert J.
AU - Hoogendoorn, Stefan
AU - van Koeverden, Sebastiaan
AU - de Korte, Fleur
AU - Oosterling, Steven J.
AU - Peeters, Koen C. M. J.
AU - Posma, Lisanne A. E.
AU - Pultrum, Bareld B.
AU - Rothbarth, Joost
AU - Rutten, Harm J. T.
AU - Schasfoort, Renske A.
AU - Schreurs, Wilhelmina H.
AU - Simons, Petra C. G.
AU - Smits, Anke B.
AU - Talsma, Aaldert K.
AU - The, G. Y. Mireille
AU - van Tilborg, Fiek
AU - Tuynman, Jurriaan B.
AU - Vanhooymissen, Inge J. S.
AU - van de Ven, Anthony W. H.
AU - Verdaasdonk, Emiel G. G.
AU - Vermaas, Maarten
AU - Vliegen, Roy F. A.
AU - Vogelaar, F. Jeroen
AU - de Vries, Marianne
AU - Vroemen, Joy C.
AU - van Vugt, Sebastiaan T.
AU - Westerterp, Marinke
AU - van Westreenen, Henderik L.
AU - de Witt, Johannes H. W.
AU - van der Zaag, Edwin S.
AU - Zimmerman, David D. E.
AU - Marijnen, Corrie A. M.
AU - Dutch Snapshot Res Grp
AU - Kusters, Miranda
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - DISSECTION
KW - MULTICENTER
U2 - 10.1245/s10434-023-13460-0
DO - 10.1245/s10434-023-13460-0
M3 - Article
C2 - 37340200
SN - 1068-9265
VL - 30
SP - 5472
EP - 5485
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 9
ER -