Current practices concerning the assessment and treatment of lateral lymph nodes in low rectal cancer: a survey among colorectal surgeons in the Netherlands

Hazen, S.M.; Sluckin, T.; Beets, G.; Hompes, R.; Tanis, P.; Kusters, M.; Dutch Lateral Node Study Grp

doi:doi:10.1080/00015458.2021.2016204

Purpose: The presence of lateral lymph nodes (LLNs) in patients with rectal cancer is notalways acknowledged by the multidisciplinary team or treated in a standardized manner,and (inter)national guidelines concerning this topic are lacking. This study aimed to evaluatecurrent practices regarding the assessment and treatment of LLNs in rectal cancer patientsbased on a survey among Dutch colorectal surgeons.Methods: An online survey was sent to members of the Dutch Association ofColoproctology. The survey consisted of 16 questions addressing their views on diagnosis,restaging, and treatment approaches for suspicious LLNs.Results: A total of 62 surgeons from 50 Dutch hospitals responded. For patients with a dis-tal cT3/T4 rectal tumor; lateral lymph node compartments were routinely discussed duringmultidisciplinary meetings in only nine hospitals (18%). When defining what makes an LLNsuspicious; the size threshold varied from >3 to >10 mm (median 7, SD 2), and MRI-basedmalignant...Show morePurpose: The presence of lateral lymph nodes (LLNs) in patients with rectal cancer is notalways acknowledged by the multidisciplinary team or treated in a standardized manner,and (inter)national guidelines concerning this topic are lacking. This study aimed to evaluatecurrent practices regarding the assessment and treatment of LLNs in rectal cancer patientsbased on a survey among Dutch colorectal surgeons.Methods: An online survey was sent to members of the Dutch Association ofColoproctology. The survey consisted of 16 questions addressing their views on diagnosis,restaging, and treatment approaches for suspicious LLNs.Results: A total of 62 surgeons from 50 Dutch hospitals responded. For patients with a dis-tal cT3/T4 rectal tumor; lateral lymph node compartments were routinely discussed duringmultidisciplinary meetings in only nine hospitals (18%). When defining what makes an LLNsuspicious; the size threshold varied from >3 to >10 mm (median 7, SD 2), and MRI-basedmalignant features were mentioned by 29 surgeons (47%). Surgeons stated eight differenttreatment strategies as their designated treatment of suspicious LLNs. A total of 33 surgeons(53%) would add a radiotherapy boost to the neoadjuvant treatment. In cases of surgicalresection; 12 surgeons (19%) would remove the suspicious LLN by ‘node-picking’ and 44 sur-geons (71%) would perform a lateral lymph node dissection. The variation was not influ-enced by hospital type or surgeon’s experience.Conclusion: These results highlight the vast variation in the awareness, definition of suspi-cious LLNs in rectal cancer, and different treatment approaches. International guidelinesbased on further research are warranted.
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Current practices concerning the assessment and treatment of lateral lymph nodes in low rectal cancer: a survey among colorectal surgeons in the Netherlands