Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer?

Objectives: We evaluated the relationship between pretreatment clinical parameters and lateral pelvic node (LPN) recurrence in patients with rectal cancer treated with a combination of curative resection and chemoradiotherapy (CRT) and attempted to identify the patients who might benefit from LPN dissection.
Methods: This study involved 900 patients between June 2001 and June 2009. Pretreatment clinical parameters including radiological size of LPN were analyzed to identify risk factors associated with long-term outcomes.
Results: Locoregional recurrence developed in 65 patients (7.2%); 42 (64.6%) had LPN recurrence, 20 (47.6%) of which had no distant metastasis. Multivariate analysis showed that LPN short-axis diameter (<5, 5-<10, and ≥10 mm) was significantly associated with LPN recurrence-free survival (5-year survival rate (5YSR), 98.2, 91.7, and 40.1%, respectively, P < 0.05), locoregional recurrence-free survival (5YSR, 95.5, 87.6, and 40.1%, respectively, P < 0.05), relapse-free survival (5YSR, 76.8, 72.5, and 30.3, respectively, P < 0.05), and overall survival (5YSR, 86.3, 83.0, and 57.5%, respectively, P < 0.05).
Conclusions: Patients with an LPN short-axis diameter ≥10 mm represent a potential subgroup at a high risk of LPN recurrence, even after CRT. Further study is needed to confirm whether LPN dissection is beneficial for these patients.
(© 2015 Wiley Periodicals, Inc.)