Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP BUSTAMANTE-LOPEZ, Leonardo Alfonso FMUSP-HC
NAHAS, Caio Sergio Rizkallah FMUSP-HC
NAHAS, Sergio Carlos FMUSP-HC
MARQUES, Carlos Frederico Sparapan FMUSP-HC
PINTO, Rodrigo Ambar FMUSP-HC
COTTI, Guilherme Cutait FMUSP-HC
MELLO, Evandro Sobroza de FMUSP-HC
dc.identifier.citation INTERNATIONAL JOURNAL OF SURGERY, v.56, p.283-287, 2018
dc.identifier.issn 1743-9191
dc.description.abstract Studies have suggested that the use of neoadjuvant chemoradiation results in a lower lymph nodes yield in rectal cancer patients. Objective: To evaluate factors associated with less than 12 lymph nodes harvested on patients with rectal cancer treated with preoperative chemoradiotherapy followed by total mesorectal excision. Patients: This was a cohort/retrospective single cancer center study. Low and mid locally advanced rectal cancer or T2N0 under risk of sphincter resection underwent chemoradiotherapy followed by total mesorectal excision with curative intent. Chemotherapy consisted of 5-FU and leucovorin IV. Total dose of pelvic radiation was 5040 Gys. All patients were staged and restaged by digital rectal examination, proctoscopy, colonoscopy, CT of abdomen and chest, and MRI of the pelvis. Patients were stratified in two groups: >= 12 and < 12 L N retrieved. The possible factors affecting number of LN were analyzed. Results: 95 patients ma the inclusion criteria. Mean LN harvest was 23.2 (3-67). 81 patients (85%) had >= 12 L N. Gender, age, tumor size, tumor stage, tumor location, length of specimen, presence of LN involvement, type of surgery, and surgical access showed no association with number of LN retrieved. Only pathological complete response showed a statistically significant association with < 12 L N on univariate (p = 0.004) and multivariate analyses (p = 0.002). Limitations: Data were collected retrospectively. The number of patients disparity between the two groups. Conclusions: Complete pathologic response is associated with < 12 L N harvested. Thus, the number of lymph nodes should not be used as a surrogate for oncologic adequacy of resection in patients with pathologic complete response.
dc.language.iso eng
dc.relation.ispartof International Journal of Surgery
dc.rights restrictedAccess
dc.subject.other randomized clinical-trial; preoperative chemoradiotherapy; tumor-regression; tnm classification; surgical specimen; open surgery; chemoradiation; carcinoma; retrieval; resection
dc.title Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision
dc.type article
dc.rights.holder Copyright ELSEVIER SCIENCE BV LIM/14 LIM/35 LIM/37
dc.identifier.doi 10.1016/j.ijsu.2018.07.001
dc.identifier.pmid 29981939
dc.type.category original article
dc.type.version publishedVersion BUSTAMANTE-LOPEZ, Leonardo Alfonso:HC:ICHC NAHAS, Caio Sergio Rizkallah:HC:ICESP NAHAS, Sergio Carlos:HC:ICHC MARQUES, Carlos Frederico Sparapan:HC:ICESP PINTO, Rodrigo Ambar:HC:ICHC COTTI, Guilherme Cutait:HC:ICESP IMPERIALE, Antonio Rocco:HC:ICESP MELLO, Evandro Sobroza de:FM:MPT RIBEIRO JUNIOR, Ulysses:FM:MGT CECCONELLO, Ivan:FM:MGT WOS:000442430500042 2-s2.0-85049589990 AMSTERDAM NETHERLANDS
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dc.description.index MEDLINE
dc.identifier.eissn 1743-9159
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