The effect of preoperative chemoradiotherapy on lymph nodes harvested in TME for rectal cancer

Stefano Scabini, Fabrizio Montecucco, Alessio Nencioni, Gabriele Zoppoli, Marina Sartini, Edoardo Rimini, Andrea Massobrio, Luisito De Marini, Alessandro Poggi, Roberto Boaretto, Emanuele Romairone, Alberto Ballestrero, Valter Ferrando, Stefano Scabini, Fabrizio Montecucco, Alessio Nencioni, Gabriele Zoppoli, Marina Sartini, Edoardo Rimini, Andrea Massobrio, Luisito De Marini, Alessandro Poggi, Roberto Boaretto, Emanuele Romairone, Alberto Ballestrero, Valter Ferrando

Abstract

Background: Adequate lymph nodes resection in rectal cancer is important for staging and local control. This retrospective analysis single center study evaluated the effect of neoadjuvant chemoradiation on the number of lymph nodes in rectal carcinoma, considering some clinicopathological parameters.

Methods: A total of 111 patients undergone total mesorectal excision for rectal adenocarcinoma from July 2005 to May 2012 in our center were included. No patient underwent any prior pelvic surgery or radiotherapy. Chemoradiotherapy was indicated in patients with rectal cancer stage II or III before chemoradiation.

Results: One-hundred and eleven patients were considered. The mean age was 67.6 yrs (range 36 - 84, SD 10.8). Fifty (45.0%) received neoadjuvant therapy before resection. The mean number of removed lymph nodes was 13.6 (range 0-39, SD 7.3). In the patients who received neoadjuvant therapy the number of nodes detected was lower (11.5, SD 6.5 vs. 15.3, SD 7.5, p = 0.006). 37.4% of patients with preoperative chemoradiotherapy had 12 or more lymph nodes in the specimen compared to the 63.6% of those who had surgery at the first step (p: 0.006).Other factors associated in univariate analysis with lower lymph nodes yield included stage (p 0.005) and grade (p 0.0003) of the tumour. Age, sex, tumor site, type of operation, surgeons and pathologists did not weight upon the number of the removed lymph nodes.

Conclusion: In TME surgery for rectal cancer, preoperative CRT results into a reduction of lymph nodes yield in univariate analisys and linear regression.

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