Metastases to Retroperitoneal or Lateral Pelvic Lymph Nodes Indicated Unfavorable Survival and High Pelvic Recurrence Rates in a Cohort of 102 Patients with Low Rectal Adenocarcinoma

Background and Objectives: The Japanese protocol considers metastases to retroperitoneal or lateral pelvic lymph nodes (RLPNs) as regional lymphatic dissemination in rectal adenocarcinoma patients and recommends total mesorectal excision (TME) plus retroperitoneal and lateral pelvic lymphadenectomy (RLPL). Western protocols consider RLPN metastases to indicate advanced disease. Methods: All outcomes were evaluated among a cohort of 102 rectal adenocarcinoma patients subjected to TME plus RLPL with a nervepreserving technique. Chemoradiotherapy was delivered in patients with T3/T4 tumors or metastases to mesorectal nodes or RLPNs. Results: Surgical mortality was 3.9%; surgical morbidity was 33.3%. Incidence of RLPN metastases was 17%. Pelvic recurrence was 14.5% in pT3/pT4 patients and 29.4% in patients with metastases to RLPNs. Survival at 50 months was 28.6% in patients with RLPN metastases versus 84.5% in patients without RLPN metastases (P < 0.0001). Survival at 50 months was 33.3% in TME stage II patients with RLPN metastases versus 97.1% in TME stage II patients without RLPN metastases (P < 0.0001), and 21.9% in TME stage III patients with RLPN metastases versus 68.9% in TME stage III patients without RLPN metastases (P ¼ 0.0237). Conclusions: Patients who underwent RLPL had acceptable morbidity and mortality rates. Metastases to RLPNs indicated unfavorable survival and considerable pelvic recurrence rates