Prognosis of lymph node metastasis confined to lateral pelvic or mesenteric nodes in mid-low rectal cancer: multicentre retrospective cohort study.

Background: Metastases in the lateral pelvic lymph nodes or mesenteric lymph nodes represent distinct categories of mid-low rectal cancer. This study investigated the patterns of mesenteric and lateral pelvic lymph node metastases in mid-low rectal cancer; the survival benefit of postoperative treatment was also analysed in these groups.

Methods: This retrospective multicentre study included consecutive patients with mid-low rectal cancer who underwent total mesorectal excision with lateral pelvic lymph node dissection in three Chinese institutions between 2012 and 2020. The primary outcome was metastatic patterns and clinicopathological features of patients with mesenteric lymph node and lateral pelvic lymph node involvement. The secondary outcome was survival.

Results: Of 566 patients treated during the study period, 407 were selected. Four lymph node metastasis patterns were compared: metastasis to both mesenteric and lateral pelvic lymph nodes (68 patients, 17%), metastasis confined to lateral pelvic lymph nodes (24 patients, 6%), metastasis confined to mesenteric lymph nodes (121 patients, 29.7%), and neither mesenteric nor lateral pelvic lymph node metastasis (194 patients, 47.7%). Patients with metastases confined to lateral pelvic nodes had a lower proportion of poor histological types (P = 0.003), lymphatic invasion (P = 0.001), and number of lateral pelvic nodal metastases (P = 0.005) compared with patients with both mesenteric and lateral pelvic lymph node metastases. Independent of preoperative treatment, metastasis confined to the lateral pelvic nodes was associated with a significantly better prognosis than metastasis in both the mesenteric and lateral pelvic lymph nodes (3-year overall survival: 78.6 versus 47.2%, P = 0.007; 3-year disease-free survival: 65.7 versus 24.9%, P = 0.011), and it was similar to that of patients with metastasis confined to the mesenteric nodes (3-year overall survival: 78.6 versus 85.4%, P = 0.559; 3-year disease-free survival: 65.7 versus 70.4%, P = 0.447).

Conclusion: Patients with metastasis confined to lateral pelvic lymph nodes have comparable pathological features and prognoses to those with metastasis confined to mesenteric nodes; such disease can be managed and treated in the same way as regional lymph node metastasis.