Lateral Lymph Nodes as the Achilles Heel of Low Rectal Cancer Surgery After Neoadjuvant Chemoradiation Therapy: Are We Close to Solving the Riddle?
Menée à partir de données portant sur 741 patients atteints d'un cancer du bas rectum de stade cT3 ou cT4 traité entre 2009 et 2013 par résection mésorectale totale en combinaison avec une radiothérapie ou une chimioradiothérapie (âge moyen : 60,4 ans ; 64,8 % d'hommes), cette étude multicentrique identifie, dans le cadre d'une première ou seconde stadification par IRM, les facteurs associés au risque de récidive locale latérale, puis évalue l'intérêt d'un curage ganglionnaire latéral chez les patients présentant un risque élevé de récidive
The management of locally advanced rectal cancer has been a topic of debate between surgical schools in the East and the West, and to date, there is still no formal consensus or mutually agreed-on guidelines. While in Western countries, neoadjuvant chemoradiation therapy followed by total mesorectal excision has been the standard of care for 2 decades now, 2 recent studies have demonstrated that this approach does not prevent lateral lymph node recurrence. On the contrary, prophylactic lateral lymph node dissection has been the standard of care for locally advanced rectal cancer in Eastern countries, with predominance in Japan. Pelvic magnetic resonance imaging (MRI) has become an invaluable instrument to establish local disease extension and lymph node involvement in locally advanced rectal cancer, with important prognostic value when it is repeated after the completion of neoadjuvant chemoradiation therapy to assess tumor response.
JAMA Surgery , commentaire, 2018