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Rifu K, Koinuma K, Horie H, Mori K, Naoi D, Tojo M, Homma Y, Murahashi S, Kihara A, Mimura T, Kitayama J, Sata N. Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review. J Anus Rectum Colon 2024; 8:259-264. [PMID: 39086877 PMCID: PMC11286367 DOI: 10.23922/jarc.2024-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/11/2024] [Indexed: 08/02/2024] Open
Abstract
Lateral lymph node (LLN) metastasis in T1 rectal cancer has an incidence of less than 1%. However, its clinical features are largely uncharted. We report a case of LLN metastasis in T1 rectal cancer and review the relevant literature. A 56-year-old female underwent rectal resection for lower rectal cancer 2 years previously (pT1bN0M0). During follow-up, an elevated tumor marker CA19-9 was documented. Enhanced CT and MRI showed a round shape nodule 2 cm in size on the left side of pelvic wall. PET-CT showed high accumulation of FDG in the same lesion, leading to a diagnosis of isolated LLN recurrence. Because no other site of recurrence was detected, surgical resection of the LLN was performed. Microscopic findings were consistent with metastatic lymph node originating from the recent rectal cancer. Adjuvant chemotherapy for six months was given, and patient remains free of recurrent disease seven months after LLN resection. Although LLN recurrence after surgery for T1 rectal cancer is rare, post-surgical follow-up should not be omitted. When LLN metastasis is suspected on CT, MRI and/or PET-CT will be recommended. Surgical resection of LLN metastasis in patients with T1 rectal cancer may lead to favorable outcomes, when recurrence in other areas is not observed.
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Affiliation(s)
- Kazuma Rifu
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Koji Koinuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Katsusuke Mori
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Daishi Naoi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Mineyuki Tojo
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Yuko Homma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Satoshi Murahashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Atsushi Kihara
- Department of Pathology, Jichi Medical University Hospital, Tochigi, Japan
| | - Toshiki Mimura
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Joji Kitayama
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
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Liu XW, Zhou B, Wu XY, Yu WB, Zhu RF. T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis: A case report. World J Clin Cases 2022; 10:12404-12409. [PMID: 36483826 PMCID: PMC9724534 DOI: 10.12998/wjcc.v10.i33.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are a few cases of lateral lymph node (LLN) metastasis (LLNM) of T1 rectal cancer. Moreover, LLNM is easily missed, especially in patients with early-stage rectal cancer. To our knowledge, the possibility of bilateral LLNM before surgery has not been reported in previous studies.
CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp. The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma. She was considered to have bilateral LLNM after the examination at our hospital. Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM. The patient received long-course adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.
CONCLUSION T1 rectal cancer could lead to LLNM and possibly, bilateral LLNM. Therefore, adequate clinical evaluation is essential for these patients.
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Affiliation(s)
- Xian-Wei Liu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Bing Zhou
- Department of Pathology, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Xiao-Yu Wu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Wen-Bing Yu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Ren-Fang Zhu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
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Sluckin TC, Couwenberg AM, Lambregts DM, Hazen SMJ, Horsthuis K, Meijnen P, Beets-Tan RG, Tanis PJ, Marijnen CA, Kusters M. Lateral lymph nodes in rectal cancer: do we all think the same? A review of multidisciplinary obstacles and treatment recommendations. Clin Colorectal Cancer 2022; 21:80-88. [DOI: 10.1016/j.clcc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/11/2022]
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Du R, Zhou J, Li D, Zhang Q, Liu J, Ma C, Wang L, Wang D. Postoperative morbidity and mortality after mesorectal excision with laparoscopic versus conventional open lateral lymph node dissection for advanced rectal cancer: A meta-analysis. Asian J Surg 2020; 44:26-35. [PMID: 32798083 DOI: 10.1016/j.asjsur.2020.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/25/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Lateral lymph node dissection (LLND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity, thus the purpose of this study is to compare the postoperative morbidity and mortality between laparoscopic and conventional open LLND after mesorectal excision (ME) for advanced rectal cancer. A comprehensive search was conducted in August 2019 based on data from PubMed, Embase, Cochrane Library, CNKI and Wanfang Data to identify relevant studies, and studies comparing laparoscopic with conventional open LLND were included. Seven studies with 335 cases in the laparoscopic LLND group and 841 cases in the conventional open LLND group were finally included. Compared with the conventional open LLND group, the laparoscopic LLND group enjoys a lower postoperative morbidity (OR = 0.47,95% CI [0.23, 0.97], P = 0.04), same postoperative mortality (Postoperative mortality in both groups was zero), shorter length of postoperative hospitalization (WMD = -5.30, 95% CI [-8.42, -2.18], P = 0.0009), less wound infection (OR = 0.40,95% CI [0.21, 0.77], P = 0.006), less intestinal obstruction (OR = 0.50,95% CI [0.29, 0.84], P = 0.009), and less urinary retention (OR = 0.61,95% CI [0.38, 0.97], P = 0.04). There were no significant differences in the incidence of anastomotic leakage, abdominal pelvic abscess and urinary tract infection between the two groups (P > 0.05). But in the sensitivity analysis, there was a significant change of urinary tract infection (OR = 0.22, 95%CI [0.06, 0.89], P = 0.03), and the degree of between-study heterogeneity decreased greatly. In conclusion, laparoscopic LLND may be a better alternative to conventional open LLND for advanced rectal cancer with lower postoperative morbidity and shorter postoperative hospital stay.
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Affiliation(s)
- Rui Du
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian, 116044, China
| | - Jiajie Zhou
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian, 116044, China
| | - Dongliang Li
- Graduate School, Medical College of Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China
| | - Qi Zhang
- Graduate School, Medical College of Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China
| | - Jiawen Liu
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian, 116044, China
| | - Changmin Ma
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian, 116044, China
| | - Liuhua Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Nantong Road No.98, Yangzhou 225001, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Nantong Road No.98, Yangzhou 225001, China.
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Laparoscopic versus Open Surgery in Lateral Lymph Node Dissection for Advanced Rectal Cancer: A Meta-Analysis. Gastroenterol Res Pract 2019; 2019:7689082. [PMID: 30956657 PMCID: PMC6425322 DOI: 10.1155/2019/7689082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022] Open
Abstract
Aim To compare the clinical efficacies between laparoscopic and conventional open surgery in lateral lymph node dissection (LLND) for advanced rectal cancer. Methods We comprehensively searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data and performed a cumulative meta-analysis. According to inclusion criteria and exclusion criteria, all eligible randomized controlled trials (RCTs) or retrospective or prospective comparative studies assessing the two techniques were included, and then a meta-analysis was performed by using RevMan 5.3 software to assess the difference in clinical and oncological outcomes between the two treatment approaches. Results Eight studies involving a total of 892 patients were finally selected, with 394 cases in the laparoscopic surgery group and 498 cases in the traditional open surgery group. Compared with the traditional open group, the laparoscopic group had a longer operative time (WMD = 81.56, 95% CI (2.09, 142.03), P = 0.008), but less intraoperative blood loss (WMD = −452.18, 95% CI (-652.23, -252.13), P < 0.00001), shorter postoperative hospital stay (WMD = −5.30, 95% CI (-8.42, -2.18), P = 0.0009), and higher R0 resection rate (OR = 2.17, 95% CI (1.14, 4.15), P = 0.02). There was no significant difference in the incidence of surgical complications between the two groups (OR = 0.52, 95% CI (0.26, 1.07), P = 0.08). Lateral lymph node harvest, lateral lymph node metastasis, local recurrence, 3-year overall survival, and 3-year disease-free survival did not differ significantly between the two approaches (P > 0.05). Conclusion Laparoscopic LLND has a similar efficacy in oncological outcomes and postoperative complications to the conventional open surgery, with the advantages of reduced intraoperative blood loss, shorter postoperative hospital stay, and higher R0 resection rate, and tumor radical cure is similar to traditional open surgery. Laparoscopic LLND is a safe and feasible surgical approach, and it may be used as a standard procedure in LLND for advanced rectal cancer.
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Tanishima H, Kimura M, Tominaga T, Iwakura S, Hoshida Y, Horiuchi T. Lateral lymph node metastasis in a patient with T1 upper rectal cancer treated by lateral lymph node dissection: a case report and brief literature review. Surg Case Rep 2017; 3:93. [PMID: 28836143 PMCID: PMC5568184 DOI: 10.1186/s40792-017-0366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022] Open
Abstract
Background Lateral lymph node (LLN) metastasis may occur in patients with advanced rectal cancers of which the lower margins are located at or below the peritoneal reflection. However, LLN metastasis from a T1 rectal cancer is rare. Here, we report a case of LLN metastasis from a T1 upper rectal cancer that was successfully treated by sequential LLN dissection. Case presentation A 56-year-old man was referred to our hospital for the treatment of a T1 upper rectal cancer. We performed a laparoscopic low anterior resection. Histological examination showed a moderately differentiated adenocarcinoma with submucosal layer invasion; the invasion depth was classified as head invasion, without vessel or lymph duct invasion. Tumor budding was classified as grade 1. A total of six lymph nodes were harvested, and no lymph node metastases were detected. The postoperative course was uneventful. At 6 months after surgery, however, the serum carcinoembryonic antigen levels were elevated, and abdominal computed tomography (CT) revealed swollen lymph nodes in the right internal and common iliac artery area. Positron emission tomography with CT revealed hot spots in the same lesions. A retrospective re-evaluation of the preoperative CT images revealed no apparent swollen lymph nodes; however, an unusual soft tissue area was detected around the right internal iliac artery. A right LLN dissection was performed. Fifteen lymph nodes were resected, and histologically, metastases of adenocarcinoma were identified in 3 nodes. The postoperative course was again uneventful. The patient was given 12 cycles of adjuvant chemotherapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin). The patient remains healthy and with no signs of recurrence at 30 months after the second surgery. Conclusions LLN metastasis occurs very rarely in patients with T1 upper rectal cancer and no risk factors for lymph node metastasis; however, a careful perioperative examination of the LLN should be performed. In cases involving LLN metastasis, a LLN dissection may be a therapeutic option if performed with curative intent.
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Affiliation(s)
- Hiroyuki Tanishima
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan.
| | - Masamichi Kimura
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Toshiji Tominaga
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Shinji Iwakura
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Yoshihiko Hoshida
- Department of Pathology, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Tetsuya Horiuchi
- Department of Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
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