Background: Lateral pelvic lymph node (LLN) metastasis (LLNM) occur in up to 28% of patients with low rectal tumours. While prophylactic lateral pelvic lymph node dissection (LLND) has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy (CRT), the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains unclear. Some studies have shown improved survival and recurrence outcomes when LLNs show "response" to CRT. However, no management algorithm exists to differentiate treatment for "responders" "non-responders".
Aim: To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.
Methods: A systemic search of PubMed and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM (s-LLNM) in rectal cancer receiving preoperative-CRT was performed.
Results: Fifteen retrospective, single-centre studies were included. 793 patients with s-LLNM were evaluated: 456 underwent TME while 337 underwent TME with LLND post-CRT. In the TME group, local recurrence (LR) rates range from 12.5% to 36%. Five-year disease free survival (DFS) was 42% to 75%. In the TME with LLND group, LR rates were 0% to 6%. Five years DFS was 41.2% to 100%. Radiological response was seen in 58%. Pathologically positive LLN was found in up to 94% of non-responders 0% to 20% in responders. Young age, low tumour location and radiological non-response were associated with final positive LLNM and lowered DFS.
Conclusion: LLND is associated with local control in patients with s-LLNM. It can be performed in radiological non-responders given a large majority represent true LLNM. Its role in radiological responders should be considered in selected high risk patients.
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http://dx.doi.org/10.4240/wjgs.v12.i5.247 | DOI Listing |
Eur J Orthop Surg Traumatol
January 2025
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Purpose: A prospective longitudinal cohort study was performed to gain insight into the course of recovery in terms of pain, opioid consumption, and mobility in patients with a lateral compression (LC) pelvic injury.
Methods: Adult patients with an LC injury, without any cognitive disorders or limited mobility and who could communicate in Dutch were asked to participate. Pain in terms of NRS (numeric rating scale, range 0-10), opioid use and mobility were recorded at eight time points: at hospital admission, and three days, one week, six weeks, three months, six months, one year and two years after the injury.
Cancers (Basel)
January 2025
Southampton Complex Cancer and Exenteration Team, University Hospital Southampton, Southampton SO16 6YD, UK.
Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however high-complexity PE is increasingly described and is defined as encompassing conventional PE with the additional resection of bone or pelvic sidewall structures.
View Article and Find Full Text PDFChirurgie (Heidelb)
January 2025
Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
Background: Lymphadenectomy for rectal cancer is clearly defined by total mesorectal excision (TME). The analogous surgical strategy for the colon, the complete mesocolic excision (CME), follows the same principles of dissection in embryologically predefined planes.
Method: This narrative review initially identified key issues related to lymphadenectomy of rectal and colon cancer.
Ann Surg Oncol
January 2025
Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China.
Background: Local relapse has not been eradicated even in the era of total mesorectum excision. Although various approaches have been attempted, R0 resection remains the only potentially curative treatment. PATIENT AND METHODS: A 45-year-old woman with a history of laparoscopic abdominoperineal resection was diagnosed with pelvic recurrence 7 months ago.
View Article and Find Full Text PDFClin Orthop Relat Res
December 2024
Naval Medical Center San Diego, San Diego, CA, USA.
Background: Femoroacetabular impingement (FAI) is a well-recognized cause of hip pain in adults. The hip-spine relationship between the femur, pelvis, and lumbosacral spine has garnered recent attention in hip arthroplasty. However, the hip-spine relationship has not been well described in patients with FAI.
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