[Spatial distribution characteristics and clinical significance of metastatic lymph nodes after neoadjuvant therapy for locally advanced mid-low rectal cancer].

Authors

S B Lu, W J Yang, G J Chen, Y L Zhu, X S Dong, Q Zhang, R S Xiang, D Y Kong, Y Sun, H R Zhang, J L Fan, L Feng, H Z Zhang

Published in

Zhonghua wai ke za zhi [Chinese journal of surgery]. Volume 64. Issue 12. Pages 1327-1336. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

Objective: To investigate the spatial distribution characteristics of metastatic lymph nodes after neoadjuvant therapy in patients with mid-low locally advanced rectal cancer (LARC) and its impact on prognosis. Methods: This is a retrospective case series analysis. The clinical and pathological data of 97 patients with mid-low LARC who received neoadjuvant therapy followed by radical resection managed a single clinical team at the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, between January 2016 and June 2025 were retrospectively analyzed. There were 59 males (60.8%) and 38 females (39.2%), with an age of (57.5±9.9) years (range: 34 to 77 years). All patients underwent D3 lymph node dissection during surgery, and regional lymph nodes were examined according to a standardized three-station protocol: first station (S1, pararectal lymph nodes), second station (S2, intermediate lymph nodes), and third station (S3, main lymph nodes). Patients were stratified according to tumor location, neoadjuvant therapy regimen and ypT stage for analyzing the spatial distribution patterns of metastatic lymph nodes. Survival analysis was performed using the Kaplan-Meier method, and potential prognostic factors for patient survival were assessed with the Cox proportional hazards model. Results: Postoperative pathological examination showed that 25.8% (25/97) of LARC patients still had lymph node metastasis (LNM) after neoadjuvant therapy. LNM was confined to S1 in 16.5% (16/97) of patients, involved S2 in 9.3% (9/97) of patients, and no patient had S3 LNM. The LNM rate among patients with ypT3-4 disease (38.5%) was significantly higher than those in patients with ypT1-2 (14.3%) and ypT0 (5.9%) disease (P=0.003). Survival analysis demonstrated that disease-free survival (DFS) of patients with S1 LNM was superior to that of patients with S2 LNM, with a statistically significant difference (Log-rank test, P=0.003). The estimated 5-year DFS rate for the S1 LNM group was approximately 100%, whereas the 5-year DFS rate for the S2 LNM group was 38.9% (95%CI: 16.2% to 93.1%). Cox proportional hazards model analysis revealed that the site of metastatic lymph nodes (HR=19.80, P=0.004) was a prognostic factor for DFS. Conclusions: The LNM rate in patients with mid-low LARC decreases after neoadjuvant therapy, with metastases predominantly concentrated in the S1 and S2 regions. For patients with mid-low LARC after neoadjuvant therapy who have no LNM-related risk factors and no definitive evidence of LNM at the root of the inferior mesenteric artery, lymph node dissection at the root of the inferior mesenteric artery may be reasonably omitted. The distribution site of metastatic lymph nodes is a potential prognostic factor and could be incorporated into the TNM staging system to refine staging and improve prognostic accuracy.

PMID:
42951855
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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