title: Indications for Lateral Pelvic Lymph Node Dissection Based on Magnetic Resonance Imaging Before and After Preoperative Chemoradiotherapy in Patients with Advanced Low-Rectal Cancer.
abstract: BACKGROUND
  We assessed the magnetic resonance imaging (MRI) findings of lateral pelvic lymph node (LPLN) metastasis in patients with advanced low-rectal cancer treated with preoperative chemoradiotherapy (CRT) and LPLN dissection (LPLD) for clinically suspected LPLN metastasis. Our aim was to identify the optimal indications for LPLD.
  
  
  METHODS
  The study population consisted of 77 patients with advanced low-rectal cancer who underwent LPLD for clinically suspicious LPLN metastasis after preoperative CRT. MRI findings before/after CRT, clinical factors, and LPLN metastasis were evaluated.
  
  
  RESULTS
  LPLN metastasis was confirmed in 31 patients (40.3 %). Metastasis was significantly higher in patients with LPLNs with a short-axis diameter ≥8 mm than in patients with LPLNs with a short-axis diameter <8 mm before CRT (75 vs. 20 %, P < 0.0001). LPLN metastasis was also significantly higher in patients with LPLNs with a short-axis diameter >5 mm than in patients with LPLNs with a short-axis diameter ≤5 mm after CRT (75 vs. 20 %, P < 0.0001). Multivariate analysis showed the independent association of female sex [P = 0.0192; odds ratio (OR) 5.616; 95 % confidence interval (CI) 1.315-28.942], pre-CRT short-axis diameter of the LPLN ≥8 mm (P = 0.0047; OR 9.188; 95 % CI 1.948-54.366), and CRT without induction systemic chemotherapy (P = 0.0285; OR 9.235; 95 % CI 1.241-106.947) with LPLN metastasis.
  
  
  CONCLUSIONS
  MRI before CRT is useful to predict LPLN metastasis and to determine the indications for LPLD.
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. takashi.akiyoshi@jfcr.or.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.affiliation: Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsueda
authors.affiliation: Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Hiratsuka
authors.affiliation: Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Unno
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nagata
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Nagasaki
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018279:Carcinoma, Signet Ring Cell / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000556:secondary* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate