title: Clinically enlarged lateral pelvic lymph nodes do not influence prognosis after neoadjuvant therapy and TME in stage III rectal cancer.
abstract: OBJECTIVE
  The significance of lateral pelvic lymph nodes (LPLN) in rectal cancer remains unclear. The purpose of this study was to determine the outcome of patients with LPLNs identified on pretherapy imaging who were treated with neoadjuvant therapy followed by proctectomy without LPLN dissection.
  
  
  METHODS
  Pretherapy imaging of patients with stage III rectal cancer was reviewed to determine perirectal and LPLN enlargement. Data were collected on preoperative therapy, operative resection, adjuvant therapy, and patient outcomes and were correlated to the presence or absence of preoperatively identified LPLNs (LPLN+ and LPLN-).
  
  
  RESULTS
  Of the 53 patients identified who were treated between 2000 and 2005, 30 (57%) were LPLN+ on preoperative imaging. All patients received preoperative radiation therapy and total mesorectal excision. The local recurrence was 13%, and there was no difference related to LPLN status. A comparison of the overall and disease-free survival in patients with and without enlarged LPLNs revealed no difference.
  
  
  CONCLUSIONS
  The LPLNs that were identified on pretherapy imaging do not affect the overall or disease-free survival after the neoadjuvant therapy and proctectomy in stage III rectal cancer. A lateral pelvic lymph node dissection does not appear to be justified in stage III patients with LPLNs on pretherapy imaging who receive neoadjuvant therapy.
authors.affiliation: Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, St. Louis, MO, USA, dharmarajans@wudosis.wustl.edu.
authors.forename: Sekhar
authors.initials: S
authors.lastname: Dharmarajan
authors.forename: Dandan
authors.initials: D
authors.lastname: Shuai
authors.forename: Alyssa D
authors.initials: AD
authors.lastname: Fajardo
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hunt
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010388:Pelvis; D012004:Rectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome