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

Dutch Snapshot Research Group, Tania C Sluckin, Sanne-Marije J A Hazen, Karin Horsthuis, Regina G H Beets-Tan, Arend G J Aalbers, Geerard L Beets, Evert-Jan G Boerma, Jaap Borstlap, Vivian van Breest Smallenburg, Jacobus W A Burger, Rogier M P H Crolla, Alette W Daniëls-Gooszen, Paul H P Davids, Michalda S Dunker, Hans F J Fabry, Edgar J B Furnée, Renza A H van Gils, Robbert J de Haas, Stefan HoogendoornSebastiaan van Koeverden, Fleur I de Korte, Steven J Oosterling, Koen C M J Peeters, Lisanne A E Posma, Bareld B Pultrum, Joost Rothbarth, Harm J T Rutten, Renske A Schasfoort, Wilhelmina H Schreurs, Petra C G Simons, Anke B Smits, Aaldert K Talsma, G Y Mireille The, Fiek van Tilborg, Jurriaan B Tuynman, Inge J S Vanhooymissen, Anthony W H van de Ven, Emiel G G Verdaasdonk, Maarten Vermaas, Roy F A Vliegen, F Jeroen Vogelaar, Marianne de Vries, Joy C Vroemen, Sebastiaan T van Vugt, Marinke Westerterp, Henderik L van Westreenen, Johannes H W de Wilt, Edwin S van der Zaag, David D E Zimmerman, Corrie A M Marijnen, Pieter J. Tanis, Miranda Kusters*

*Corresponding author voor dit werk

    OnderzoeksoutputAcademicpeer review

    5 Citaten (Scopus)
    30 Downloads (Pure)

    Samenvatting

    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.

    Originele taal-2English
    Pagina's (van-tot)5472–5485
    Aantal pagina's14
    TijdschriftAnnals of surgical oncology
    Volume30
    Vroegere onlinedatum20-jun.-2023
    DOI's
    StatusPublished - sep.-2023

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