Management of Responsive Lateral Pelvic Nodes After Neoadjuvant Therapy in Rectal Cancer (RESPONDER)

OBJECTIVE: To determine whether lateral pelvic lymph node dissection improves oncological outcomes in patients with rectal cancer with radiologically responsive lateral pelvic nodes (LPNs) following neoadjuvant chemoradiotherapy (nCRT). SUMMARY BACKGROUND DATA: The optimal management of radiologically responsive LPNs after nCRT remains unclear. METHODS: This retrospective cohort study included patients with mid-to-low rectal adenocarcinoma who underwent radical resection between 2012 and 2022 at eight tertiary centers. Eligible patients had baseline magnetic resonance imaging evidence of lateral pelvic node enlargement (short-axis ≥5 mm) that decreased to <5 mm after nCRT. Inverse probability of treatment weighting was used to address selection bias. Weighted Kaplan-Meier and Cox proportional hazards models were used to compare disease-free survival, overall survival, and local recurrence. RESULTS: Of 844 patients, 451 underwent total mesorectal excision alone and 393 underwent total mesorectal excision with LPN dissection. Dissection was associated with longer operative time (279.3 vs. 237.9 min; P<0.001) and higher early complication rates (27.0% vs. 19.6%; P=0.011). The 5-year local recurrence, disease-free survival, and overall survival rates were 3.1% vs. 5.3% (hazard ratio [HR], 0.738; 95% confidence interval [CI], 0.207-2.634; P=0.640), 77.1% vs. 71.4% (HR, 0.80; 95% CI, 0.50-1.29), and 87.0% vs. 86.9% (HR, 0.79; 95% CI, 0.22-2.81) with and without lymph node dissection, respectively. CONCLUSIONS: Among patients with radiologically responsive LPNs after nCRT, omission of lateral pelvic lymph node dissection did not compromise oncological outcomes. These data support a response-based surgical strategy to reduce operative morbidity without affecting recurrence or survival rates.

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Journal
Annals of Surgery
Published
2026-05-22
DOI
https://doi.org/10.1097/sla.0000000000007099
Primary Topic
Colorectal Cancer Surgical Treatments
Type
article
Field-Weighted Citation Impact
0.00

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article

Management of Responsive Lateral Pelvic Nodes After Neoadjuvant Therapy in Rectal Cancer (RESPONDER)

I J Park, Ji Won Park, Seung Yoon Yang, Eunjeong Ji et al.
Annals of Surgery
Colorectal Cancer Surgical Treatments
article

Management of Responsive Lateral Pelvic Nodes After Neoadjuvant Therapy in Rectal Cancer (RESPONDER)

I J Park, Ji Won Park, Seung Yoon Yang, Eunjeong Ji, Seung Ho Song, Sung Seo Hwang, Kyong-Min Kang, Jin Kim, Park, Yoon Suk Lee, In Kyu Lee, Jung Hoon Bae, Sung Chan Park, Duck-Woo Kim, Soyeon Ahn, Gyu-Seog Choi, Heung-Kwon Oh, Jae Hwan Oh, Byung Soh Min, Seung-Yong Jeong, Ki Ho You, Sung-Bum Kang, Min Jung Kim, Seung-Bum Ryoo
article en

Abstract

OBJECTIVE: To determine whether lateral pelvic lymph node dissection improves oncological outcomes in patients with rectal cancer with radiologically responsive lateral pelvic nodes (LPNs) following neoadjuvant chemoradiotherapy (nCRT). SUMMARY BACKGROUND DATA: The optimal management of radiologically responsive LPNs after nCRT remains unclear. METHODS: This retrospective cohort study included patients with mid-to-low rectal adenocarcinoma who underwent radical resection between 2012 and 2022 at eight tertiary centers. Eligible patients had baseline magnetic resonance imaging evidence of lateral pelvic node enlargement (short-axis ≥5 mm) that decreased to <5 mm after nCRT. Inverse probability of treatment weighting was used to address selection bias. Weighted Kaplan-Meier and Cox proportional hazards models were used to compare disease-free survival, overall survival, and local recurrence. RESULTS: Of 844 patients, 451 underwent total mesorectal excision alone and 393 underwent total mesorectal excision with LPN dissection. Dissection was associated with longer operative time (279.3 vs. 237.9 min; P<0.001) and higher early complication rates (27.0% vs. 19.6%; P=0.011). The 5-year local recurrence, disease-free survival, and overall survival rates were 3.1% vs. 5.3% (hazard ratio [HR], 0.738; 95% confidence interval [CI], 0.207-2.634; P=0.640), 77.1% vs. 71.4% (HR, 0.80; 95% CI, 0.50-1.29), and 87.0% vs. 86.9% (HR, 0.79; 95% CI, 0.22-2.81) with and without lymph node dissection, respectively. CONCLUSIONS: Among patients with radiologically responsive LPNs after nCRT, omission of lateral pelvic lymph node dissection did not compromise oncological outcomes. These data support a response-based surgical strategy to reduce operative morbidity without affecting recurrence or survival rates.

Annals of Surgery
Ulsan College (KR), Seoul National University (KR), Korea University (KR), Kyungpook National University Hospital (KR), Asan Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), University of Ulsan (KR), National Cancer Center (KR), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Yonsei University Health System (KR), Catholic University of Korea (KR)
National Research Foundation of Korea
Good health and well-being
Openalex Percentile: Top 7%
Colorectal Cancer Surgical Treatments
DOISourceOpenAlex
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