Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study

H.M. Kroon; S. Malakorn; N.N. Dudi-Venkata; S. Bedrikovetski; J.L. Liu; T. Kenyon-Smith; B.K. Bednarski; A. Ogura; C.J.H. van de Velde; H.J.T. Rutten; G.L. Beets; M.L. Thomas; M. Kusters; G.R.J. Chang; T. Sammour

doi:10.1016/j.ejso.2021.06.004

Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study

H.M. Kroon^*, S. Malakorn, N.N. Dudi-Venkata, S. Bedrikovetski, J.L. Liu, T. Kenyon-Smith, B.K. Bednarski, A. Ogura, C.J.H. van de Velde, H.J.T. Rutten, G.L. Beets, M.L. Thomas, M. Kusters, G.R.J. Chang, T. Sammour

^*Corresponding author for this work

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Abstract

Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (>5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND-(p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent sig-nificant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Original language	English
Pages (from-to)	2441-2449
Number of pages	9
Journal	European Journal of Surgical Oncology
Volume	47
Issue number	9
DOIs	https://doi.org/10.1016/j.ejso.2021.06.004
Publication status	Published - 1 Sept 2021

Keywords

Low rectal cancer
Locally advanced rectal cancer
Neoadjuvant (chemo)radiotherapy
Lateral lymph nodes
Lateral lymph node dissection
JAPANESE SOCIETY
CHEMORADIOTHERAPY
CHEMORADIATION
GUIDELINES
RESECTION
EXCISION
OUTCOMES
COLON

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10.1016/j.ejso.2021.06.004

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Kroon, H. M., Malakorn, S., Dudi-Venkata, N. N., Bedrikovetski, S., Liu, J. L., Kenyon-Smith, T., Bednarski, B. K., Ogura, A., van de Velde, C. J. H., Rutten, H. J. T., Beets, G. L., Thomas, M. L., Kusters, M., Chang, G. R. J., & Sammour, T. (2021). Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study. European Journal of Surgical Oncology, 47(9), 2441-2449. https://doi.org/10.1016/j.ejso.2021.06.004

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title = "Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study",

abstract = "Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (>5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND-(p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent sig-nificant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.",

keywords = "Low rectal cancer, Locally advanced rectal cancer, Neoadjuvant (chemo)radiotherapy, Lateral lymph nodes, Lateral lymph node dissection, JAPANESE SOCIETY, CHEMORADIOTHERAPY, CHEMORADIATION, GUIDELINES, RESECTION, EXCISION, OUTCOMES, COLON",

author = "H.M. Kroon and S. Malakorn and N.N. Dudi-Venkata and S. Bedrikovetski and J.L. Liu and T. Kenyon-Smith and B.K. Bednarski and A. Ogura and {van de Velde}, C.J.H. and H.J.T. Rutten and G.L. Beets and M.L. Thomas and M. Kusters and G.R.J. Chang and T. Sammour",

year = "2021",

month = sep,

day = "1",

doi = "10.1016/j.ejso.2021.06.004",

language = "English",

volume = "47",

pages = "2441--2449",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "9",

}

Kroon, HM, Malakorn, S, Dudi-Venkata, NN, Bedrikovetski, S, Liu, JL, Kenyon-Smith, T, Bednarski, BK, Ogura, A, van de Velde, CJH, Rutten, HJT, Beets, GL, Thomas, ML, Kusters, M, Chang, GRJ & Sammour, T 2021, 'Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study', European Journal of Surgical Oncology, vol. 47, no. 9, pp. 2441-2449. https://doi.org/10.1016/j.ejso.2021.06.004

Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study. / Kroon, H.M.; Malakorn, S.; Dudi-Venkata, N.N. et al.
In: European Journal of Surgical Oncology, Vol. 47, No. 9, 01.09.2021, p. 2441-2449.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study

AU - Kroon, H.M.

AU - Malakorn, S.

AU - Dudi-Venkata, N.N.

AU - Bedrikovetski, S.

AU - Liu, J.L.

AU - Kenyon-Smith, T.

AU - Bednarski, B.K.

AU - Ogura, A.

AU - van de Velde, C.J.H.

AU - Rutten, H.J.T.

AU - Beets, G.L.

AU - Thomas, M.L.

AU - Kusters, M.

AU - Chang, G.R.J.

AU - Sammour, T.

PY - 2021/9/1

Y1 - 2021/9/1

N2 - Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (>5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND-(p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent sig-nificant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

AB - Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (>5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND-(p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent sig-nificant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

KW - Low rectal cancer

KW - Locally advanced rectal cancer

KW - Neoadjuvant (chemo)radiotherapy

KW - Lateral lymph nodes

KW - Lateral lymph node dissection

KW - JAPANESE SOCIETY

KW - CHEMORADIOTHERAPY

KW - CHEMORADIATION

KW - GUIDELINES

KW - RESECTION

KW - EXCISION

KW - OUTCOMES

KW - COLON

U2 - 10.1016/j.ejso.2021.06.004

DO - 10.1016/j.ejso.2021.06.004

M3 - Article

C2 - 34120810

SN - 0748-7983

VL - 47

SP - 2441

EP - 2449

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 9

ER -

Kroon HM, Malakorn S, Dudi-Venkata NN, Bedrikovetski S, Liu JL, Kenyon-Smith T et al. Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study. European Journal of Surgical Oncology. 2021 Sept 1;47(9):2441-2449. doi: 10.1016/j.ejso.2021.06.004

Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study

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