Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

Tania C. Sluckin; Sanne Marije J.A. Hazen; Dutch Snapshot Research Group; Karin Horsthuis; Regina G.H. Beets-Tan; Arend G.J. Aalbers; Geerard L. Beets; Evert Jan G. Boerma; Jaap Borstlap; Vivian van Breest Smallenburg; Jacobus W.A. Burger; Rogier M.P.H. Crolla; Alette W. Daniëls-Gooszen; Paul H.P. Davids; Michalda S. Dunker; Renza A.H. van Gils; Sebastiaan van Koeverden; Steven J. Oosterling; Joost Rothbarth; Aaldert K. Talsma; Inge J.S. Vanhooymissen; Emiel G.G. Verdaasdonk; Maarten Vermaas; Marianne de Vries; Pieter J. Tanis; Susanna M. van Aalten; Imogeen E. Antonisse; David W.G.ten Cate; Sam Curutchet; Emmelie N. Dekker; Ahmet Demirkiran; Laurentine S.E. van Egdom; Youssef El-Massoudi; Saskia van Elderen; Sjoerd van den Hoek; Christiaan Hoff; Farshad Imani; Sylvia Kok; Ingrid M. Koster; Leonard F. Kroese; Karin Muller; Bo J. Noordman; Pim B. Olthof; Jan M. van Rees; Lodewijk J. Roosen; Ernst J. Spillenaar-Bilgen; Maxime J.M. van der Valk; Laura A. Velema; Paul P. van Westerveld; Kang J. Zheng

doi:10.1245/s10434-023-13460-0

Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

Tania C. Sluckin, Sanne Marije J.A. Hazen, Dutch Snapshot Research Group, Karin Horsthuis, Regina G.H. Beets-Tan, Arend G.J. Aalbers, Geerard L. Beets, Evert Jan G. Boerma, Jaap Borstlap, Vivian van Breest Smallenburg, Jacobus W.A. Burger, Rogier M.P.H. Crolla, Alette W. Daniëls-Gooszen, Paul H.P. Davids, Michalda S. Dunker, Renza A.H. van Gils, Sebastiaan van Koeverden, Steven J. Oosterling, Joost Rothbarth, Aaldert K. TalsmaInge J.S. Vanhooymissen, Emiel G.G. Verdaasdonk, Maarten Vermaas, Marianne de Vries, Pieter J. Tanis, Susanna M. van Aalten, Imogeen E. Antonisse, David W.G.ten Cate, Sam Curutchet, Emmelie N. Dekker, Ahmet Demirkiran, Laurentine S.E. van Egdom, Youssef El-Massoudi, Saskia van Elderen, Sjoerd van den Hoek, Christiaan Hoff, Farshad Imani, Sylvia Kok, Ingrid M. Koster, Leonard F. Kroese, Karin Muller, Bo J. Noordman, Pim B. Olthof, Jan M. van Rees, Lodewijk J. Roosen, Ernst J. Spillenaar-Bilgen, Maxime J.M. van der Valk, Laura A. Velema, Paul P. van Westerveld, Kang J. Zheng

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Abstract

Background: Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either ‘node-picking’ (the removal of an individual LLN) or ‘partial regional node dissection’ (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. Results: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.

Original language	English
Pages (from-to)	5472-5485
Number of pages	14
Journal	Annals of Surgical Oncology
Volume	30
Issue number	9
DOIs	https://doi.org/10.1245/s10434-023-13460-0
Publication status	Published - 20 Jun 2023

Bibliographical note

Funding Information:
The Snapshot Rectal Cancer 2016 study received funding from the Dutch Cancer Society (KWF; reference number 12768).

Publisher Copyright:
© 2023, The Author(s).

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Sluckin, T. C., Hazen, S. M. J. A., Dutch Snapshot Research Group, Horsthuis, K., Beets-Tan, R. G. H., Aalbers, A. G. J., Beets, G. L., Boerma, E. J. G., Borstlap, J., van Breest Smallenburg, V., Burger, J. W. A., Crolla, R. M. P. H., Daniëls-Gooszen, A. W., Davids, P. H. P., Dunker, M. S., van Gils, R. A. H., van Koeverden, S., Oosterling, S. J., Rothbarth, J., ... Zheng, K. J. (2023). Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting. Annals of Surgical Oncology, 30(9), 5472-5485. https://doi.org/10.1245/s10434-023-13460-0

@article{d11e4b6e0bdd4d57ac1a96691d942ae6,

title = "Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting",

abstract = "Background: Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either {\textquoteleft}node-picking{\textquoteright} (the removal of an individual LLN) or {\textquoteleft}partial regional node dissection{\textquoteright} (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. Results: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.",

author = "Sluckin, {Tania C.} and Hazen, {Sanne Marije J.A.} and {Dutch Snapshot Research Group} and Karin Horsthuis and Beets-Tan, {Regina G.H.} and Aalbers, {Arend G.J.} and Beets, {Geerard L.} and Boerma, {Evert Jan G.} and Jaap Borstlap and {van Breest Smallenburg}, Vivian and Burger, {Jacobus W.A.} and Crolla, {Rogier M.P.H.} and Dani{\"e}ls-Gooszen, {Alette W.} and Davids, {Paul H.P.} and Dunker, {Michalda S.} and {van Gils}, {Renza A.H.} and {van Koeverden}, Sebastiaan and Oosterling, {Steven J.} and Joost Rothbarth and Talsma, {Aaldert K.} and Vanhooymissen, {Inge J.S.} and Verdaasdonk, {Emiel G.G.} and Maarten Vermaas and {de Vries}, Marianne and Tanis, {Pieter J.} and {van Aalten}, {Susanna M.} and Antonisse, {Imogeen E.} and Cate, {David W.G.ten} and Sam Curutchet and Dekker, {Emmelie N.} and Ahmet Demirkiran and {van Egdom}, {Laurentine S.E.} and Youssef El-Massoudi and {van Elderen}, Saskia and {van den Hoek}, Sjoerd and Christiaan Hoff and Farshad Imani and Sylvia Kok and Koster, {Ingrid M.} and Kroese, {Leonard F.} and Karin Muller and Noordman, {Bo J.} and Olthof, {Pim B.} and {van Rees}, {Jan M.} and Roosen, {Lodewijk J.} and Spillenaar-Bilgen, {Ernst J.} and {van der Valk}, {Maxime J.M.} and Velema, {Laura A.} and {van Westerveld}, {Paul P.} and Zheng, {Kang J.}",

note = "Funding Information: The Snapshot Rectal Cancer 2016 study received funding from the Dutch Cancer Society (KWF; reference number 12768). Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = jun,

day = "20",

doi = "10.1245/s10434-023-13460-0",

language = "English",

volume = "30",

pages = "5472--5485",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer Science+Business Media",

number = "9",

}

Sluckin, TC, Hazen, SMJA, Dutch Snapshot Research Group, Horsthuis, K, Beets-Tan, RGH, Aalbers, AGJ, Beets, GL, Boerma, EJG, Borstlap, J, van Breest Smallenburg, V, Burger, JWA, Crolla, RMPH, Daniëls-Gooszen, AW, Davids, PHP, Dunker, MS, van Gils, RAH, van Koeverden, S, Oosterling, SJ, Rothbarth, J, Talsma, AK, Vanhooymissen, IJS, Verdaasdonk, EGG, Vermaas, M, de Vries, M, Tanis, PJ, van Aalten, SM, Antonisse, IE, Cate, DWGT, Curutchet, S, Dekker, EN, Demirkiran, A, van Egdom, LSE, El-Massoudi, Y, van Elderen, S, van den Hoek, S, Hoff, C, Imani, F, Kok, S, Koster, IM, Kroese, LF, Muller, K, Noordman, BJ , Olthof, PB , van Rees, JM, Roosen, LJ, Spillenaar-Bilgen, EJ, van der Valk, MJM, Velema, LA, van Westerveld, PP & Zheng, KJ 2023, 'Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting', Annals of Surgical Oncology, vol. 30, no. 9, pp. 5472-5485. https://doi.org/10.1245/s10434-023-13460-0

TY - JOUR

T1 - Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

AU - Sluckin, Tania C.

AU - Hazen, Sanne Marije J.A.

AU - Dutch Snapshot Research Group

AU - Horsthuis, Karin

AU - Beets-Tan, Regina G.H.

AU - Aalbers, Arend G.J.

AU - Beets, Geerard L.

AU - Boerma, Evert Jan G.

AU - Borstlap, Jaap

AU - van Breest Smallenburg, Vivian

AU - Burger, Jacobus W.A.

AU - Crolla, Rogier M.P.H.

AU - Daniëls-Gooszen, Alette W.

AU - Davids, Paul H.P.

AU - Dunker, Michalda S.

AU - van Gils, Renza A.H.

AU - van Koeverden, Sebastiaan

AU - Oosterling, Steven J.

AU - Rothbarth, Joost

AU - Talsma, Aaldert K.

AU - Vanhooymissen, Inge J.S.

AU - Verdaasdonk, Emiel G.G.

AU - Vermaas, Maarten

AU - de Vries, Marianne

AU - Tanis, Pieter J.

AU - van Aalten, Susanna M.

AU - Antonisse, Imogeen E.

AU - Cate, David W.G.ten

AU - Curutchet, Sam

AU - Dekker, Emmelie N.

AU - Demirkiran, Ahmet

AU - van Egdom, Laurentine S.E.

AU - El-Massoudi, Youssef

AU - van Elderen, Saskia

AU - van den Hoek, Sjoerd

AU - Hoff, Christiaan

AU - Imani, Farshad

AU - Kok, Sylvia

AU - Koster, Ingrid M.

AU - Kroese, Leonard F.

AU - Muller, Karin

AU - Noordman, Bo J.

AU - Olthof, Pim B.

AU - van Rees, Jan M.

AU - Roosen, Lodewijk J.

AU - Spillenaar-Bilgen, Ernst J.

AU - van der Valk, Maxime J.M.

AU - Velema, Laura A.

AU - van Westerveld, Paul P.

AU - Zheng, Kang J.

PY - 2023/6/20

Y1 - 2023/6/20

N2 - Background: Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either ‘node-picking’ (the removal of an individual LLN) or ‘partial regional node dissection’ (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. Results: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.

AB - Background: Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods: Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either ‘node-picking’ (the removal of an individual LLN) or ‘partial regional node dissection’ (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. Results: Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion: Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.

UR - http://www.scopus.com/inward/record.url?scp=85161677548&partnerID=8YFLogxK

U2 - 10.1245/s10434-023-13460-0

DO - 10.1245/s10434-023-13460-0

M3 - Article

C2 - 37340200

AN - SCOPUS:85161677548

SN - 1068-9265

VL - 30

SP - 5472

EP - 5485

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 9

ER -

Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting

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