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Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis.

Authors
 Byung Soh Min  ;  Jin Soo Kim  ;  Nam Kyu Kim  ;  Joon-Seok Lim  ;  Kang Young Lee  ;  Chang Hwan Cho  ;  Seung Kook Sohn 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.16(12) : 3271-3278, 2009 
Journal Title
 ANNALS OF SURGICAL ONCOLOGY 
ISSN
 1068-9265 
Issue Date
2009
MeSH
Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/secondary ; Adenocarcinoma/surgery* ; Adenocarcinoma, Mucinous/diagnostic imaging ; Adenocarcinoma, Mucinous/secondary ; Adenocarcinoma, Mucinous/surgery* ; Female ; Humans ; Lymph Node Excision* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Radiography ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Survival Rate
Keywords
Rectal Cancer ; Extended Lymph Node Dissection ; Pelvic Magnetic Resonance Imaging ; Lateral Node Metastasis ; Lateral Pelvic Node
Abstract
BACKGROUND: The purpose of this study is to review the clinical outcomes of patients who received extended lymph node dissection for radiologically diagnosed extramesenteric lymph node metastasis. PATIENTS AND METHODS: The authors reviewed clinical characteristics, short-term operative outcomes, and long-term oncologic outcomes of 151 patients who had received total mesorectal excision plus extended lymph node dissection for the treatment of radiologically diagnosed extramesenteric lymph node metastasis. RESULTS: The positive predictive value of the radiologic diagnosis of extramesenteric lymph node metastasis was 86.4% for lateral nodes and 40.0% for para-aortic nodes. It showed improvement over time. Perioperative mortality occurred in 3 patients (2.0%) and morbidity in 31 patients (20.5%). Pathologic examinations revealed metastatic para-aortic lymph nodes in 43 patients (PA) and metastatic lateral pelvic nodes in 36 patients (LP), while in 21 patients, metastasis was found in both (LP + PA). Both cancer-specific survival (CSS) and disease-free survival (DFS) were significantly different according to the extent of node metastasis (CSS: P < .001; DFS: P < .001) and univariate and multivariate analyses for prognostic factors revealed that the lymph node status as to location was the only factor. CONCLUSION: Patients with extramesenteric lymph node metastasis may be a distinct subgroup with poor prognosis. Extended lymph node dissection may have a role for those patients. However, the optimal treatment strategy remains inconclusive, for which further clinical research is necessary.
Full Text
http://link.springer.com/article/10.1245%2Fs10434-009-0692-1
DOI
10.1245/s10434-009-0692-1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Jin Soo(김진수)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Lee, Kang Young(이강영)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Cho, Chang Hwan(조장환)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/105499
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