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Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection?

Publication ,  Journal Article
Stipa, F; Zernecke, A; Moore, HG; Minsky, BD; Wong, WD; Weiser, M; Paty, PB; Shia, J; Guillem, JG
Published in: Ann Surg Oncol
February 2004

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).

Duke Scholars

Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

February 2004

Volume

11

Issue

2

Start / End Page

187 / 191

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Rectal Neoplasms
  • Oncology & Carcinogenesis
  • New York City
  • Neoplasm, Residual
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Stipa, F., Zernecke, A., Moore, H. G., Minsky, B. D., Wong, W. D., Weiser, M., … Guillem, J. G. (2004). Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol, 11(2), 187–191. https://doi.org/10.1245/aso.2004.06.010
Stipa, Francesco, Alma Zernecke, Harvey G. Moore, Bruce D. Minsky, W Douglas Wong, Martin Weiser, Philip B. Paty, Jinru Shia, and Jose G. Guillem. “Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection?Ann Surg Oncol 11, no. 2 (February 2004): 187–91. https://doi.org/10.1245/aso.2004.06.010.
Stipa F, Zernecke A, Moore HG, Minsky BD, Wong WD, Weiser M, et al. Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol. 2004 Feb;11(2):187–91.
Stipa, Francesco, et al. “Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection?Ann Surg Oncol, vol. 11, no. 2, Feb. 2004, pp. 187–91. Pubmed, doi:10.1245/aso.2004.06.010.
Stipa F, Zernecke A, Moore HG, Minsky BD, Wong WD, Weiser M, Paty PB, Shia J, Guillem JG. Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol. 2004 Feb;11(2):187–191.
Journal cover image

Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

February 2004

Volume

11

Issue

2

Start / End Page

187 / 191

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Rectal Neoplasms
  • Oncology & Carcinogenesis
  • New York City
  • Neoplasm, Residual
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Incidence