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MRI-detected extramural vascular invasion potentiates the risk for pathological metastasis to the lateral lymph nodes in rectal cancer

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Abstract

Purpose

Multidisciplinary treatment for locally advanced rectal cancer requires an accurate assessment of the risk of metastasis to the lateral lymph nodes (LNs). We herein aimed to stratify the risk of pathological metastasis to lateral LNs based on the preoperatively detected malignant features.

Methods

All patients with rectal cancer who underwent surgery from January 2016 to July 2020 were identified. We recorded the TNM factors; perirectal and lateral LN sizes; and MRI findings, including mesorectal fascia involvement, extramural vascular invasion (EMVI), tumor site, and tumor distance from the anal verge.

Results

101 patients underwent rectal resection with lateral lymph node dissection, of whom 16 (15.8%) exhibited pathological metastases to the lateral LNs. Univariate analyses demonstrated that lateral LN metastasis was significantly correlated with mrEMVI positivity (p = 0.0023) and a baseline lateral LN short-axis length of ≥ 5 mm (p < 0.0001). These significant associations were confirmed by a multivariate analysis (p = 0.0254 and 0.0027, respectively). The lateral LN metastasis rate was as high as 44% in cases bearing both risk factors, compared to 0% in cases lacking both risk factors.

Conclusion

The results elucidated in this study may contribute to risk stratification, which can be used when determining the indications for lateral lymph node dissection.

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Acknowledgements

None to be declared.

Funding

This study received no funding.

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Authors and Affiliations

  1. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan

    Atsushi Hamabe, Masayuki Ishii, Kenji Okita, Toshihiko Nishidate, Koichi Okuya, Emi Akizuki, Ryo Miura, Takahiro Korai & Ichiro Takemasa

  2. Department of Diagnostic Radiology, Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan

    Koichi Onodera & Masamitsu Hatakenaka

Authors
  1. Atsushi Hamabe
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  2. Masayuki Ishii
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Contributions

Study concept and design (AH, MI, KO, MH, IT); acquisition of data (AH, MI, KO, KO, TN, KO, EA, RM, TK); analysis and interpretation of data (AH, MI, KO, KO, TN, KO, MH, IT); statistical analysis (AH, MI, KO); drafting of the manuscript (AH, MI, KO, MH, IT).

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Correspondence to Ichiro Takemasa.

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Supplementary Information

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595_2021_2250_MOESM1_ESM.eps

Supplementary Fig 1 Receiver-operating characteristic curve used to analyze the prognostic efficacy of lateral lymph node short-axis length for the risk of pathological metastasis to lateral lymph nodes. The white circle indicates the point at which the cutoff value is 5 mm. The area under the receiver-operating characteristic curve is 0.874 (EPS 141 KB)

595_2021_2250_MOESM2_ESM.tiff

Supplementary Fig. 2 Relapse-free survival rate of patients who had a follow-up period of over three years according to mrEMVI positivity (TIFF 7047 KB)

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Hamabe, A., Ishii, M., Onodera, K. et al. MRI-detected extramural vascular invasion potentiates the risk for pathological metastasis to the lateral lymph nodes in rectal cancer. Surg Today 51, 1583–1593 (2021). https://doi.org/10.1007/s00595-021-02250-4

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  • DOI: https://doi.org/10.1007/s00595-021-02250-4

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