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Wyatt J, Powell SG, Ahmed S, Arthur J, Altaf K, Ahmed S, Javed MA. Inguinal lymph node metastases from rectal adenocarcinoma: a systematic review. Tech Coloproctol 2023; 27:969-978. [PMID: 37233960 PMCID: PMC10562269 DOI: 10.1007/s10151-023-02826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making. METHODS Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias. RESULTS Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92-1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59-93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53-78%. CONCLUSION In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.
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Affiliation(s)
- James Wyatt
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK.
| | - Simon G Powell
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - Salma Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - James Arthur
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Kiran Altaf
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Shakil Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Muhammad Ahsan Javed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
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2
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Sato H, Maeda K, Kinugasa Y, Kagawa H, Tsukamoto S, Takahashi K, Nozawa H, Takii Y, Konishi T, Akagi Y, Suto T, Yamaguchi S, Ozawa H, Komori K, Ohue M, Hiro J, Shinji S, Minami K, Shimizu T, Sakamoto K, Uehara K, Takahashi H, Sugihara K. Management of inguinal lymph node metastases from rectal and anal canal adenocarcinoma. Colorectal Dis 2022; 24:1150-1163. [PMID: 35505622 DOI: 10.1111/codi.16169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/08/2023]
Abstract
AIM The surgical treatment of inguinal lymph node (ILN) metastases secondary to anorectal adenocarcinoma remains controversial. This study aimed to clarify the surgical treatment and management of ILN metastasis according to its classification. METHODS This retrospective, multi-centre, observational study included patients with synchronous or metachronous ILN metastases who were diagnosed with rectal or anal canal adenocarcinoma between January 1997 and December 2011. Treatment outcomes were analysed according to recurrence and prognosis. RESULTS Among 1181 consecutively enrolled patients who received treatment for rectal or anal canal adenocarcinoma at 20 referral hospitals, 76 (6.4%) and 65 (5.5%) had synchronous and metachronous ILN metastases, respectively. Among 141 patients with ILN metastasis, differentiated carcinoma, solitary ILN metastasis and ILN dissection were identified as independent predictive factors associated with a favourable prognosis. No significant difference was found in the frequency of recurrence after ILN dissection between patients with synchronous (80.6%) or metachronous (81.0%) ILN metastases. Patients who underwent R0 resection of the primary tumour and ILN dissection had a 5-year survival rate of 41.3% after ILN dissection (34.1% and 53.1% for patients with synchronous and metachronous ILN metastases, respectively, P = 0.55). CONCLUSION The ILN can be appropriately classified as a regional lymph node in rectal and anal canal adenocarcinoma. Moreover, aggressive ILN dissection might be effective in improving the prognosis of low rectal and anal canal adenocarcinoma with ILN metastases; thus, prophylactic ILN dissection is unnecessary.
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Affiliation(s)
- Harunobu Sato
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Yusuke Kinugasa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyasu Kagawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Shunsuke Tsukamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keiichi Takahashi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
| | - Hiroaki Nozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasumasa Takii
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tsuyoshi Konishi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yoshito Akagi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takeshi Suto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shigeki Yamaguchi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,Division of Colorectal Surgery, Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Heita Ozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Koji Komori
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Ohue
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichiro Hiro
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Seiichi Shinji
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuhito Minami
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomoharu Shimizu
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Medical Safety Section, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiro Sakamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kay Uehara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Takahashi
- Department of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Sugihara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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3
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Sun Y, Lin Y, Liu Z, Jiang W, Chi P. Combined laparoscopic lymphoadenectomy of lateral pelvic and inguinal nodal metastases using indocyanine green fluorescence imaging guidance in low rectal cancer after preoperative chemoradiotherapy: a case report. BMC Gastroenterol 2022; 22:123. [PMID: 35296259 PMCID: PMC8925188 DOI: 10.1186/s12876-022-02193-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intraoperative near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) can demonstrate real-time lymphatic drainage and thus improve the accuracy and completeness of lymphadenectomy in colorectal cancer surgery. However, it has not been utilized in the inguinal lymphadenectomy in rectal cancer. This study aimed to describe a case of combined laparoscopic lymphadenectomy of left lateral pelvic and inguinal nodal metastases using NIR imaging with ICG imaging guidance for a rectal cancer patient with left lateral pelvic and inguinal lymph node metastases. Case presentation A 26-year-old man presented rectal cancer located 7 cm from the anal verge and enlarged lymph nodes in the left inguinal area. Pretreatment workup revealed rectal cancer with left lateral pelvic and inguinal lymph node metastases. The patient received preoperative chemoradiotherapy (pCRT), including radiation (total dose of 50.4 Gy in 28 fractions) to the whole pelvis and bilateral inguinal regions together with eight cycles of FOLFOX (oxaliplatin, fluoropyrimidine, and leucovorin) and three cycles of bevacizumab targeted chemotherapy. After pCRT, both colonoscopy and MR scan revealed a significant response of the primary tumor to pCRT, while MR scan revealed enlarged left lateral pelvic and inguinal lymph nodes. After four months from the completion of radiation (2 months after the last course of bevacizumab targeted therapy), the patient underwent laparoscopic-assisted ultra-low anterior resection and lymphadenectomy of left lateral pelvic and inguinal nodal metastases using ICG-NIR fluorescence imaging. The combined procedure was performed successfully without perioperative complication. Total operative time was 480 min and estimated blood loss 50 mL. Totally 34 lymph nodes were retrieved. Conclusions This is the first report of the safety and feasibility of ICG-NIR fluorescence imaging-guided laparoscopic lymphadenectomy of left lateral pelvic and inguinal nodal metastases in managing low rectal cancer with lateral pelvic and inguinal LNs metastases. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02193-1.
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Affiliation(s)
- Yanwu Sun
- Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, Fuzhou, Fujian, People's Republic of China.,Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yu Lin
- Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, Fuzhou, Fujian, People's Republic of China.,Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Zhun Liu
- Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Weizhong Jiang
- Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, Fuzhou, Fujian, People's Republic of China.,Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China. .,Department of Colorectal Surgery and General Surgery, Fujian Medical University, Union Hospital, Fuzhou, Fujian, People's Republic of China. .,Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China. .,Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
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4
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Abd El Aziz MA, McKenna NP, Jakub JW, Hallemeier CL, Kelley SR, Jin Z, Mathis KL. Rectal cancer with synchronous inguinal lymph node metastasis without distant metastasis. A call for further oncological evaluation. Eur J Surg Oncol 2021; 48:1100-1103. [PMID: 34953643 DOI: 10.1016/j.ejso.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to compare the survival of patients with isolated inguinal lymph node metastases from rectal cancer to patients with inguinal and additional synchronous distant metastases from rectal cancer who treated with curative intent. A retrospective review of all consecutive adult patients with rectal adenocarcinoma and inguinal lymph node involvement who underwent curative therapy at our institution from 2002 to 2020 was conducted. Patients were classified as having synchronous inguinal lymph node metastasis (SILNM), or synchronous inguinal lymph node and distant organ metastasis (SILNDOM). Patients in the SILNM group had a median overall survival of 75 months compared to 17.6 months in the SILNDOM group;p-value = 0.09. The recurrence-free survival for patients with SILNM was 19.6 months compared to 2.4 months in the SILNDOM group;p-value = 0.053. In conclusion, SILNM appears to represent a distinct subgroup of patients with metastatic rectal cancer. These patients warrant consideration of treatment with curative intent. Further studies are needed.
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Affiliation(s)
- Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | | | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Zhaohui Jin
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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5
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Chen M, Liu S, Xu M, Yi HC, Liu Y, He F. Radiation boost for synchronous solitary inguinal lymph node metastasis during neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Discov Oncol 2021; 12:59. [PMID: 35201468 PMCID: PMC8777535 DOI: 10.1007/s12672-021-00455-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Some patients with locally advanced rectal cancer (LARC) present with inguinal lymph node metastases without evidence of other systemic disease, known as solitary inguinal lymph node metastasis (SILNM). These patients may represent a distinct subset who have a more favorable prognosis and should be treated with curative intent. The optimal treatment strategy for these patients has not been determined. METHODS We retrospectively reviewed 16 consecutive LARC patients diagnosed between January 2017 and December 2019, who had SILNM, were treated with an inguinal lymph nodes (ILN) radiation boost with curative intent during neoadjuvant chemoradiotherapy (nCRT) and underwent total mesorectal excision (TME). We used Kaplan-Meier survival curves to calculate survival rates, and recorded radiation-related toxicity. RESULTS None of these 16 patients developed pelvic or inguinal recurrences, and 3 of the patients developed distant metastases. The 3-year overall survival rate and locoregional relapse-free survival rate were both 100%. The 3-year disease-free rate and distant metastasis-free survival rate were both 81.3%. Of 5 patients who had ILN dissection for suspicious ILNs after neoadjuvant treatment, 2 had residual nodal tumor confirmed. Grade 3 toxicity was found in 5 patients, and no patients had lymphedema or other grade 4 or 5 toxicities. CONCLUSIONS In LARC patients with synchronous SILNM, a radiation boost to the ILNs during nCRT achieved excellent local control with acceptable toxicity. Though the optimal treatment strategy remains unclear, nCRT with an ILN radiation boost prior to TME may be a reasonable therapeutic approach to consider for this subset of patients.
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Affiliation(s)
- Mo Chen
- Radiotherapy Department of Thorax and Abdomen Carcinoma, Cancer Center, The First People's Hospital of Foshan, Foshan, China
| | - Shuai Liu
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 YuanCun ErHeng Road, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Guangzhou, China
| | - Meng Xu
- Radiotherapy Department of Thorax and Abdomen Carcinoma, Cancer Center, The First People's Hospital of Foshan, Foshan, China
| | - Han-Chen Yi
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 YuanCun ErHeng Road, Guangzhou, 510655, Guangdong, China
| | - Yanping Liu
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 YuanCun ErHeng Road, Guangzhou, 510655, Guangdong, China.
| | - Fang He
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 YuanCun ErHeng Road, Guangzhou, 510655, Guangdong, China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Guangzhou, China.
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6
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Tanabe T, Shida D, Komukai S, Nakamura Y, Tsukamoto S, Kanemitsu Y. Long-term outcomes after surgical dissection of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma. BMC Cancer 2019; 19:733. [PMID: 31340778 PMCID: PMC6657054 DOI: 10.1186/s12885-019-5956-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 07/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The 8th edition of the tumor-node-metastasis (TNM) classification classifies inguinal lymph nodes as regional lymph nodes for anal canal carcinoma but non-regional lymph nodes for rectal carcinoma. This difference might reflect the different prognosis of inguinal lymph node metastasis from anal canal carcinoma and rectal carcinoma. However, long-term outcomes of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma are unclear, which we aimed to investigate in this study. Methods The study population included 31 consecutive patients with rectal or anal canal adenocarcinoma who underwent inguinal lymph node dissection with curative intent at the National Cancer Center Hospital from 1986 to 2017. Long-term outcomes were assessed and clinicopathologic variables analyzed for prognostic significance. Results Of the 31 patients, 12 patients had rectal adenocarcinoma and 19 patients had anal canal adenocarcinoma. Synchronous metastasis were observed in 14 patients and metachronous metastasis in 17 patients. After dissection of inguinal lymph node metastasis with curative intent, the 5-year overall survival rate was 55.2%, with 12 patients surviving for more than 5 years. Median survival time was 66.6 months. Multivariate analyses revealed that location of primary tumor (rectum versus anal canal) was not a prognostic factor, whereas lateral lymph node metastasis and histological findings were independent prognostic factors. Conclusion Given the good prognosis, inguinal lymph node metastasis in patients with rectal or anal canal adenocarcinoma appears to be regional rather than distant. If R0 resection can be achieved, inguinal lymph node dissection may be indicated for these patients.
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Affiliation(s)
- Taro Tanabe
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuya Nakamura
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
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7
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Hagemans JAW, Rothbarth J, van Bogerijen GHW, van Meerten E, Nuyttens JJME, Verhoef C, Burger JWA. Treatment of Inguinal Lymph Node Metastases in Patients with Rectal Adenocarcinoma. Ann Surg Oncol 2019; 26:1134-1141. [PMID: 30725310 PMCID: PMC6399178 DOI: 10.1245/s10434-019-07191-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal lymph node metastases (ILNM) from rectal adenocarcinoma are rare and staged as systemic disease. This study aimed to provide insight into the treatment and prognosis of ILNM from rectal adenocarcinoma. METHODS All patients with a diagnosis of synchronous or metachronous ILNM from rectal adenocarcinoma between January 2005 and March 2017 were retrospectively reviewed. RESULTS The study identified 27 patients with ILNM (15 with synchronous and 12 with metachronous disease). After discussion by a multidisciplinary tumor board, 19 patients were treated with curative intent, 17 of whom underwent inguinal lymph node dissection. Of the 17 patients, 12 had locally advanced rectal cancer (LARC) with isolated ILNM, 3 had LARC and metastases elsewhere, and 2 had locally recurrent rectal cancer (LRRC). The median overall survival (OS) for all the patients treated with curative intent was 27 months [95% confidence interval (CI) 11.6-42.4 months], with a 5-year OS rate of 34%. The median OS for the patients with LARC and isolated ILNM (n = 12) was 74 months (95% CI 18.0-130.0 months), with a 5-year OS rate of 52%. All the patients with metastases elsewhere (n = 3) or LRRC (n = 2) experienced recurrent systemic disease. Eight patients were treated with palliative intent. The median OS for this group was 13 months (95% CI 1.9-24.1 months), with a 3-year OS rate of 0%. CONCLUSION Clinicians should not consider ILNM as an incurable systemic disease. Patients with primary rectal cancer and solitary ILNM who were eligible for curative surgical treatment had a 5-year survival rate of 52%. The prognosis for patients with additional systemic metastases or LRRC is worse, and the benefit of surgery is unclear.
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Affiliation(s)
- J A W Hagemans
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - J Rothbarth
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - G H W van Bogerijen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J J M E Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J W A Burger
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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8
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Zuhdy M, Elbalka SS, Hamdy O, Raafat S, Saleh GA, Abdelazez MA, Roshdy S. A Totally Laparoendoscopic Approach for Low Rectal Cancer with Inguinal Nodal Metastasis. J Laparoendosc Adv Surg Tech A 2019; 29:60-64. [PMID: 30130134 DOI: 10.1089/lap.2018.0442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Isolated inguinal nodal metastasis from rectal cancer is rare with better oncological outcome in case of surgical resection. METHODS We report a rectal cancer case with inguinal nodal metastasis that was operated using a totally endoscopic approach. Laparoscopic intersphincteric resection was done for rectal cancer and video endoscopic inguinal lymphadenectomy (VEIL) for inguinal lymph nodes. The patient was presented to and managed in the Oncology Center, Mansoura University, Egypt. RESULTS The patient had an uneventful postoperative course with better outcome than open surgery. CONCLUSIONS Incorporation of minimally invasive approaches such as laparoscopy and VEIL in the management of inguinal nodal metastasis from rectal cancer can have a great impact on the patient's quality of life without affecting the oncologic outcome.
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Affiliation(s)
- Mohammed Zuhdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Saleh Saleh Elbalka
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Omar Hamdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Sara Raafat
- 2 Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- 3 Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mai AbdAllah Abdelazez
- 4 Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- 1 Surgical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
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9
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Bin Traiki T, Khalessi A, Phan-Thien KC. Inguinal lymph node metastases from rectal adenocarcinoma. ANZ J Surg 2017; 89:431-433. [PMID: 28681989 DOI: 10.1111/ans.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Thamer Bin Traiki
- Division of General Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amirala Khalessi
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kim-Chi Phan-Thien
- St George Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Kitano Y, Kuramoto M, Masuda T, Kuroda D, Yamamoto K, Ikeshima S, Iyama KI, Shimada S, Baba H. Ascending colon cancer with synchronous external iliac and inguinal lymph node metastases but without regional lymph node metastasis: a case report and brief literature review. Surg Case Rep 2017; 3:32. [PMID: 28220469 PMCID: PMC5318304 DOI: 10.1186/s40792-017-0309-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/15/2017] [Indexed: 01/30/2023] Open
Abstract
Lymph node metastasis to the iliac or inguinal region of colon cancer is extremely rare. We experienced a case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases but without any regional lymph node metastasis. An 83-year-old woman was admitted to our hospital due to anemia. Colonoscopy and computed tomography revealed an ascending colon cancer and also right external iliac and inguinal lymph node swelling. Further examination by F-deoxyglucose positron emission tomography strongly suggested that these lymph nodes were metastatic. Right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed. Histological examination revealed that both lymph nodes were metastasized from colon cancer, and there was no evidence of regional lymph node metastasis. The patient has shown no sign of recurrence at 27 months after surgery.
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Affiliation(s)
- Yuki Kitano
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kuramoto
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, 10-10 Tohricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Toshiro Masuda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Daisuke Kuroda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kenichiro Yamamoto
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, 10-10 Tohricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Satoshi Ikeshima
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, 10-10 Tohricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Ken-Ichi Iyama
- Department of Surgical Pathology, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, 10-10 Tohricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Shinya Shimada
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, 10-10 Tohricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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11
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Yeo SG, Lim HW, Kim DY, Kim TH, Kim SY, Baek JY, Chang HJ, Park JW, Oh JH. Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal? Radiat Oncol 2014; 9:296. [PMID: 25533887 PMCID: PMC4299686 DOI: 10.1186/s13014-014-0296-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background We investigated whether routine elective irradiation of a clinically negative inguinal node (IGN) is necessary for patients with locally advanced distal rectal cancer and anal canal invasion (ACI). Methods We reviewed retrospectively 1,246 patients with locally advanced rectal adenocarcinoma managed using preoperative or postoperative chemoradiotherapy and radical surgery between 2001 and 2011. The patients’ IGN was clinically negative at presentation and IGN irradiation was not performed. ACI was defined as the lower edge of the tumor being within 3 cm of the anal verge. Patients were divided into two groups, those with ACI (n = 189, 15.2%) and without ACI (n = 1,057, 84.8%). Results The follow-up period was a median of 66 months (range, 3–142 months). Among the 1,246 patients, 10 developed IGN recurrence; 7 with ACI and 3 without ACI. The actuarial IGN recurrence rate at 5 years was 0.7%; 3.5% and 0.2% in patients with and without ACI, respectively (p < 0.001). Isolated IGN recurrence occurred in three patients, all of whom had ACI tumors. These three patients received curative intent local treatments, and one was alive with no evidence of disease 10 years after IGN recurrence. Salvage treatments in the other two patients controlled successfully the IGN recurrence for >5 years, but they developed second malignancy or pelvic and distant recurrences. Seven patients with non-isolated IGN recurrence died of disease at 5–22 months after IGN recurrence. Conclusion The low IGN recurrence rate even with ACI and the feasibility of salvage of isolated IGN recurrence indicated that routine elective IGN irradiation is not necessary for rectal cancer with ACI.
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Affiliation(s)
- Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Choenan, Korea.
| | - Hyeon Woo Lim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Dae Yong Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea. .,Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Tae Hyun Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Sun Young Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Ji Yeon Baek
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Hee Jin Chang
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Ji Won Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
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12
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Fujita S. Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis. Int J Colorectal Dis 2014; 29:1077-80. [PMID: 24972679 DOI: 10.1007/s00384-014-1940-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with lower rectal cancer occasionally have limited extramesorectal lymph node metastasis. However, the incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis remain unclear. METHODS A total of 714 patients with clinical stage II or III lower rectal cancer who underwent extramesorectal lymph node dissection at the National Cancer Center Hospital between 1985 and 2011 were reviewed. RESULTS Among the 714 patients with lower rectal cancer, 35 (4.9 %) had limited extramesorectal lymph node metastasis, of whom 28 (80.0 %) had one or two extramesorectal lymph node metastases. The 5-year overall survival rate was 74.5 %. The number of extramesorectal lymph node metastases was a significant prognostic factor. The 5-year overall survival rate of patients with three or more extramesorectal lymph node metastases was 28.6 %. CONCLUSIONS The incidence of limited extramesorectal lymph node metastasis in patients with lower rectal cancer was 4.9 %. Although the prognosis of patients with one or two extramesorectal lymph node metastases was favorable, that of patients with three or more such metastases was unfavorable.
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Affiliation(s)
- Shin Fujita
- Colorectal Surgery Division, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-ku, Tokyo, 104-0045, Japan,
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13
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Percutaneous Cryoablation for Local Control of Metachronous Inguinal Lymph Node Metastases. Cardiovasc Intervent Radiol 2014; 38:1369-72. [PMID: 24981465 DOI: 10.1007/s00270-014-0946-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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14
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Li Q, Wang Y, Cai G, Li D, Cai S. Solitary lymph node metastasis is a distinct subset of colon cancer associated with good survival: a retrospective study of surveillance, epidemiology, and end-results population-based data. BMC Cancer 2014; 14:368. [PMID: 24885443 PMCID: PMC4070651 DOI: 10.1186/1471-2407-14-368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
Background Colon cancer with lymph node metastases has been considered as advanced stage and to have poor survival. We postulated that patients with solitary lymph node metastasis are a distinct subset with better colon cancer-specific survival than those with multiple lymph node metastases. Methods In this retrospective study, we searched Surveillance, Epidemiology, and End-Results (SEER) population-based data and identified 86,674 patients who had been diagnosed with colon cancer without distant metastases and with less than three metastatic nodes between 1991 and 2005. We divided lymph node status into three subgroups: pN0, pN1a, and pN1b and obtained 5-year colon cancer-specific survival for each pT stage. We used Kaplan–Meier and multivariate Cox regression models to assess correlations between risk factors and survival outcomes. Results Analysis of SEER data confirmed that patients with solitary lymph node metastases had better 5-year cancer-specific survival than pN1b according to both univariate and multivariate analysis. This finding was confirmed by further analyses in five pT subgroups. Cancer-specific survival of patients with pT1-2N1a was comparable to that of those with pIIA but higher than those with pIIB. In addition, survival of patients with pT3-4aN1a was better than those with pIIC. Conclusion Colon cancer patients with solitary lymph node metastasis are a distinct subset with a favorable prognosis; full consideration should be given to this in clinical practice.
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Affiliation(s)
| | | | | | | | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai 20032, China.
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15
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TAKEUCHI D, KOIDE N, SUZUKI A, OGIWARA H, ISHIZONE S, MIYAGAWA S. Outcomes of Inguinal Node Dissection for Metastases from Anal Canal Carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.3919/jjsa.75.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Adachi T, Hinoi T, Egi H, Ohdan H. Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome. Int J Colorectal Dis 2013; 28:1675-80. [PMID: 23836116 DOI: 10.1007/s00384-013-1746-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE No consensus has been formed on the optimal treatment strategy for the prognosis of patients with inguinal lymph node (ILN) metastasis from lower rectal adenocarcinoma. We, therefore, retrospectively analyzed outcomes of patients with ILN metastasis from lower rectal adenocarcinoma. METHODS Of 323 patients with lower rectal adenocarcinoma treated at a single institution between November 1993 and March 2010, 10 had synchronous or metachronous ILN metastasis, as confirmed by curative resection (R0) of the primary lesion. Outcomes of these 10 patients were assessed. RESULTS The 10 patients with ILN metastasis were divided into two groups: group A (two patients who did not undergo ILN resection surgery because of metastases at other sites) and group B (eight patients with no other metastases who underwent surgery). Both patients in group A, with median overall survival of 5.2 months, died due to the other metastases, whereas five out of eight patients in group B survived (P = 0.001). Group B patients were further subclassified into synchronous (group B1) and metachronous (group B2) metastasis (n = 4 each) groups. Two patients in group B1 died of other metastases, which was diagnosed later, whereas three patients in group B2 survived. CONCLUSIONS Some patients with isolated inguinal lymph node metastasis show a good prognosis after lymph node excision and, therefore, should be treated surgically. Patients with metachronous metastases have a better prognosis than patients with synchronous ILN metastases. Nevertheless, assessment of additional patients for prognosis and treatment strategy is warranted.
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Affiliation(s)
- Tomohiro Adachi
- Department of Surgery, Division of Frontier Medical Sciences, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, 7348551, Hiroshima, Japan,
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17
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Perez RO, Habr-Gama A, São Julião GP, Proscurshim I, Ono CR, Lynn P, Bailão Aguilar P, Nahas SC, Gama-Rodrigues J, Buchpiguel CA. Clinical relevance of positron emission tomography/computed tomography-positive inguinal nodes in rectal cancer after neoadjuvant chemoradiation. Colorectal Dis 2013; 15:674-82. [PMID: 23374979 DOI: 10.1111/codi.12159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/16/2013] [Indexed: 02/08/2023]
Abstract
AIM Inguinal nodes may be a possible route for lymphatic spread in patients with distal rectal cancer. The outcome was examined for patients with distal rectal cancer undergoing neoadjuvant chemoradiation (CRT) and having 2-fluorine-18-fluoro-2-deoxy-d-glucose (FDG)-avid inguinal nodes using positron emission tomography/computed tomography (PET/CT) imaging. METHOD Ninety-nine consecutive patients with cT2-4N0-2M0 distal rectal adenocarcinoma were enrolled in a clinical trial (NCT00254683) and underwent baseline PET/CT followed by 54 Gy and 5-fluorouracil-based CRT. After CRT, patients underwent 6- and 12-week PET/CT. Patients with positive inguinal node uptake were compared with patients with negative uptake. The inguinal region was not included in the field of radiation therapy. RESULTS Seventeen (17%) patients had baseline positive inguinal node FDG uptake. They were more likely to have the tumour closer to the anal verge (2.0 vs 4.2 cm; P = 0.001). Of these, eight (47%) demonstrated a positive inguinal uptake at PET/CT after 12 weeks from CRT. Patients with inguinal node FDG uptake after CRT (positive PET at baseline and 12 weeks) had a significantly worse 3-year overall and disease-free survival (P = 0.02 and P = 0.03). After a median follow-up period of 22 months, none of these patients had developed inguinal recurrence. CONCLUSION Uptake of inguinal nodes at PET/CT may be present in up to 17% of patients with distal rectal cancer, particularly with ultra-low tumours. Nearly half of these nodes no longer show uptake after CRT despite the groin area not being included in the radiation field. Persistence of inguinal node uptake 12 weeks after CRT completion may be a marker for worse oncological outcome.
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Affiliation(s)
- R O Perez
- Angelita and Joaquim Gama Institute, Sao Paulo, Brazil.
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18
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Hara M, Takahashi H, Sato M, Takayama S, Nagasaki T, Takeyama H. Curatively resected isolated inguinal lymph node metastasis from cecum cancer: report of a case. Surg Today 2012; 43:88-90. [PMID: 23111463 DOI: 10.1007/s00595-012-0380-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 05/12/2011] [Indexed: 11/27/2022]
Abstract
We herein report the case of a curatively resected solitary inguinal lymph node metastasis from cecum cancer. Our patient was a 67-year-old male with cecum cancer with abdominal wall invasion. Three years after surgery, inguinal lymph node swelling was detected by a computed tomography examination. Further examination revealed no other metastases. Surgical resection was performed to remove the lesion, and microscopic examination revealed that cancer cells had metastasized. No recurrence was detected 3 years after the salvage surgery. Inguinal lymph node metastasis of cecum cancer has not been reported in the literature, but in our case salvage surgery resulted in a good outcome.
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Affiliation(s)
- Masayasu Hara
- Department of Gastroenterological Surgery, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
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Pisanu A, Deplano D, Reccia I, Parodo G, Uccheddu A. Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon. World J Surg Oncol 2011; 9:128. [PMID: 21999113 PMCID: PMC3206842 DOI: 10.1186/1477-7819-9-128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 10/14/2011] [Indexed: 11/25/2022] Open
Abstract
This study aimed to describe an unusual case of metachronous isolated inguinal lymph nodes metastasis from sigmoid carcinoma. A 62-year-old man was referred to our department because of an obstructing sigmoid carcinoma. Colonoscopy showed the obstructing lesion at 30 cm from the anal verge and abdominal CT revealed a sigmoid lesion infiltrating the left lateral abdominal wall. The patient underwent a colonic resection extended to the abdominal wall. Histology showed an adenocarcinoma of the colon infiltrating the abdominal wall with iuxtacolic nodal involvement. Thirty three months after surgery abdominal CT and PET scan revealed a metastatic left inguinal lymph node involvement. The metastatic lymph node was found strictly adherent to the left iliac-femoral artery and encompassing the origin of the left inferior epigastric artery. Histology showed a metachronous nodal metastasis from colonic adenocarcinoma. Despite metastastic involvement of inguinal lymph node from rectal cancer is a rare but well known clinical entity, to the best of our knowledge, this is the first report of inguinal metastasis from a carcinoma of the left colon. Literature review shows only three other similar reported cases: two cases of inguinal metastasis secondary to adenocarcinoma of the cecum and one case of axillary metastasis from left colonic carcinoma. A metastatic pathway through superficial abdominal wall lymphatic vessels could be possible through the route along the left inferior epigastric artery. The solitary inguinal nodal involvement from rectal carcinoma could have a more favorable prognosis. In the case of nodal metastasis to the body surface lymph nodes from colonic carcinoma, following the small number of such cases reported in the literature, no definitive conclusions can be drawn.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy.
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Damin DC, Tolfo GC, Rosito MA, Spiro BL, Kliemann LM. Sentinel lymph node in patients with rectal cancer invading the anal canal. Tech Coloproctol 2010; 14:133-9. [PMID: 20424879 DOI: 10.1007/s10151-010-0582-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 03/19/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND To assess the feasibility of the sentinel lymph node procedure in patients with rectal cancer extending to the anal canal. METHODS Between January 2005 and April 2008, 15 patients with adenocarcinoma of the rectum with direct invasion of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel node procedure consisted of a combination of preoperative radiocolloid lymphoscintigraphy and intraoperative detection of the inguinal sentinel node with a gamma probe. Patent blue dye was also used to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin-eosin staining and immunohistochemistry. RESULTS Detection and removal of inguinal sentinel nodes was possible in all patients. Four patients (26.7%) had sentinel nodes identified as positive for metastatic adenocarcinoma. All positive cases also had metastases detected in perirectal lymph nodes; three of them developed hepatic or pulmonary metastases within 6 months after surgery. Of the 11 patients with negative sentinel nodes, only four (36.4%) also presented metastatic perirectal lymph nodes. Although none of the negative cases developed late inguinal metastases, three developed systemic or pelvic recurrence within 12 months after surgery. CONCLUSIONS The standardized procedure was highly effective in sampling inguinal sentinel nodes in very low rectal cancers, allowing the detection of subclinical metastatic disease. Although this technique can be potentially useful for a subgroup of patients with isolated inguinal metastases, it cannot be routinely recommended for patients with rectal tumors invading the anal canal at this moment.
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Affiliation(s)
- D C Damin
- Department of Surgery, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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