Annals of Surgical Oncology

, Volume 19, Issue 12, pp 3713–3718 | Cite as

Evaluation of Lymphadenectomy in Patients Receiving Neoadjuvant Radiotherapy for Rectal Adenocarcinoma

  • Maithao Le
  • Rebecca Nelson
  • Wendy Lee
  • Brian Mailey
  • Marjun Duldulao
  • Yi-Jen Chen
  • Julio Garcia-Aguilar
  • Joseph Kim
Colorectal Cancer

Abstract

Background

Accurate pathologic staging has been shown to correlate with outcome in rectal cancer. Because the exact number of examined lymph nodes (LNs) may vary with preoperative therapies, our objective was to measure the impact of neoadjuvant radiation on LN number for rectal adenocarcinoma.

Methods

Patients who underwent curative-intent radical surgery for rectal adenocarcinoma in Los Angeles County (LAC) were identified from the Cancer Surveillance Program (CSP) of California (1988–2006). Patients were grouped according to receipt of radiotherapy (neoadjuvant or none), and the number of examined LNs was assessed.

Results

Query of CSP identified 2,727 patients meeting eligibility criteria; 70 and 30 % of patients received no radiotherapy or neoadjuvant radiotherapy (NRT), respectively. When comparing LNs, a lower mean number was observed in the neoadjuvant group than the no-radiation group (7 vs. 8.9 LNs, respectively; p < 0.001). When matching the cohorts for age and sex, the neoadjuvant group still had fewer examined LNs (7.1 vs. 9.8, respectively, p < 0.001). In patients who received NRT, no optimal LN number was associated with improved survival. However, on subset analysis of patients with N0 disease, a LN number of ≥8 was associated with best rates of 5 year and overall survival.

Conclusions

Within the LAC population, we observed a lower number of LNs retrieved in patients receiving radical surgery for rectal cancer than guideline recommendation. This number is reduced further in those who received NRT independent of age and sex. Our results highlight the limitations in adhering to minimum LN requirements for rectal cancer when NRT is provided.

Keywords

Rectal Cancer Total Mesorectal Excision National Comprehensive Cancer Network National Comprehensive Cancer Network Rectal Cancer Patient 

Notes

Acknowledgment

The authors thank Nicola Solomon, PhD, for assistance in writing and editing this article.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Maithao Le
    • 1
  • Rebecca Nelson
    • 2
  • Wendy Lee
    • 1
  • Brian Mailey
    • 1
  • Marjun Duldulao
    • 1
  • Yi-Jen Chen
    • 3
  • Julio Garcia-Aguilar
    • 1
  • Joseph Kim
    • 1
  1. 1.Department of SurgeryCity of Hope Comprehensive Cancer CenterDuarteUSA
  2. 2.Department of BiostatisticsCity of Hope Comprehensive Cancer CenterDuarteUSA
  3. 3.Department of Radiation OncologyCity of Hope Comprehensive Cancer CenterDuarteUSA

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