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Session: ePoster Monitor 6-Rectal Cancer 1

eP209 - Is There a Role for Lateral Lymph Node Dissection in Locally Advanced Rectal Cancer? A Decision Tree Analysis

Sunday, June 2, 2024
8:36 AM – 8:41 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    Author(s)

  • David M. Habib, MD

    Research Fellow
    Adventhealth
    AdventHealth
    Orlando, FL, United States

    Disclosure information not submitted.

    • Author(s)

  • LB

    Leonardo A. Bustamante-Lopez, MD, Ph.D

    Colorectal Surgeon
    Adventhealth
    Sanford, Florida, United States

    Disclosure information not submitted.

  • Matthew Albert, MD, FACS, FASCRS

    Medical Director, Surgical Innovation DHSI
    AdventHealth
    Orlando, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • ePoster Presenter(s)

  • Christopher T. Aquina, MD, MPH

    Assistant Professor
    AdventHealth Orlando
    Orlando, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • John RT Monson, MD

    Professor of Surgery
    Northwell Health
    Northwell Health
    Ridgefield, CT, United States

    Disclosure information not submitted.

Purpose/Background: The role of lateral lymph node dissection (LLND) in patients with rectal cancer remains highly controversial balancing proposed benefits against technical challenges and additional morbidity. The literature is unclear on these matters. Using published data and a decision tree approach for a hypothetical patient with locally advanced low rectal cancer with involved lateral pelvic lymph nodes (LPLNs) on pre-treatment imaging, we compared the value of neoadjuvant chemoradiotherapy (nCRT) plus total mesorectal excision alone (TME) with nCRT plus both TME and lateral pelvic lymph node dissection (LPLND).Methods/Interventions: The decision tree analysis was constructed using post-operative complications, 5-year local recurrence, and 5-year overall survival rates for TME vs LPLND. The value of each health state was reported in utility values to estimate perceived quality of life following outcomes of each treatment option.Results/Outcomes: The decision tree model calculated the value of TME at 0.59 and that of LPLND at 0.63, thus concluding that LPLND is of higher value in treating those patients with locally advanced low rectal cancer with involved lateral pelvic lymph nodes on pre-treatment imaging. However, the difference seems to be negligible from a clinical perspective.Conclusion/

Discussion: For patients who receive neoadjuvant chemoradiotherapy for locally advanced low rectal cancer with involved LPLNs on pre-treatment imaging, TME alone is of similar value to TME plus LPLND. Although there is a small improvement in cancer-specific outcomes after selected LLND, this evidence-based decision tree analysis does not support the widespread adoption of this technique.Decision tree structureDecision tree branches including morbidity, recurrence, and survival data.
LLN: lateral lymph nodes, nCRT: neoadjuvant chemoradiotherapy, TME: Total mesorectal excision, LLND: TME + lateral lymph node dissection.