title: Prognostic value of lateral lymph node metastasis for advanced low rectal cancer.
abstract: OBJECTIVE
  To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer.
  
  
  METHODS
  A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified.
  
  
  RESULTS
  Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter >or= 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (c2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (c2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (c2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (c2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 +/- 2.1 m, 95% CI: 76.7-85.1 m vs 38 +/- 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001).
  
  
  CONCLUSIONS
  Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter >or= 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.
authors.affiliation: Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou 510080, Guangdong Province, China.
authors.forename: Ze-Yu
authors.initials: ZY
authors.lastname: Wu
authors.forename: Jin
authors.initials: J
authors.lastname: Wan
authors.forename: Jing-Hua
authors.initials: JH
authors.lastname: Li
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yao
authors.forename: Jia-Lin
authors.initials: JL
authors.lastname: Du
authors.forename: Quan-Fang
authors.initials: QF
authors.lastname: Liu
authors.forename: Lin
authors.initials: L
authors.lastname: Peng
authors.forename: Zhi-Du
authors.initials: ZD
authors.lastname: Wang
authors.forename: Zhi-Ming
authors.initials: ZM
authors.lastname: Huang
authors.forename: Hua-Huan
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors