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MRI Guides Surgical Decision-Making for Lateral Pelvic Lymph Node Metastases in Rectal Cancer

By MedImaging International staff writers
Posted on 28 Jul 2022

Image: LPLN metastases are an important cause of preventable local failure in rectal cancer (Photo courtesy of Pexels)

Lateral pelvic lymph node (LPLN) metastasis is an important clinical problem in rectal cancer, and there is no global consensus on how to treat it. In Western countries, locally advanced rectal cancer is typically treated with total neoadjuvant therapy (TNT) and total mesorectal excision (TME). LPLN dissection (LPLND) traditionally has been performed in Eastern countries but has not been widely adopted in the West due to concerns about potential morbidity and technical difficulty. Now, a new study has evaluated clinical and oncological outcomes following magnetic resonance imaging (MRI)-directed surgical selection for LPLND after TNT.

The retrospective single-institution study by researchers at The University of Texas MD Anderson Cancer Center (Houston, TX, USA) examined outcomes when MRI was used to facilitate appropriate selection of patients requiring additional surgery, or LPLND, following TNT. A retrospective consecutive cohort analysis was performed of rectal cancer patients with enlarged LPLN on pre-treatment MRI. Patients were categorized as LPLND or non-LPLND. The main outcomes were lateral local recurrence rate, perioperative and oncological outcomes and factors associated with decision-making for LPLND.

The study identified 158 patients with enlarged pre-treatment LPLNs who received TNT; 88 patients (56.0%) underwent LPLND, after MRI assessment by a multidisciplinary team. The MD Anderson team reported good outcomes for LPLND with major morbidity (19.3% vs. 17%) and recurrence rates (3.4% vs. 4.6%) that did not differ between the patients who did and did not receive LPLND, indicating that MRI can be used to select patients for LPLND.

Based on these findings, the researchers concluded that for rectal cancer patients with evidence of LPLN metastasis, the appropriate selection of patients for LPLND can be facilitated by a multidisciplinary MRI directed approach with no significant difference in perioperative or oncologic outcomes.

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71 (403.88107299805): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (53.167343139648): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (68.187713623047): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (25.98762512207): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.186508178711): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (111.81831359863): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

105 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

106 (50.783157348633): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (45.061111450195): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

109 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

110 (58.174133300781): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (484.94338989258): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (458.95576477051): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (364.78042602539): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

116 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

117 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

118 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

119 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

120 (295.87745666504): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 41318.17817688): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (196.93374633789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

123 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

124 (!!!!! 6060.8386993408): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794069 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794069 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 951933.86077881): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 504214.04838562): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (324.96452331543): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (39.815902709961): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (216.00723266602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (180.00602722168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (51.975250244141): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (512.83836364746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (358.10470581055): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (240.08750915527): SELECT name FROM jos_deeppockets WHERE id=212

136 (38.14697265625): SELECT name FROM jos_deeppockets WHERE id=212

137 (437.97492980957): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (346.89903259277): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (953.91273498535): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

140 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

141 (!!!!! 12088.060379028): TRUNCATE TABLE jos_trademed_module

142 (70.095062255859): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (600.09956359863): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794069 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (358.10470581055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (!!!!! 2736.0916137695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

147 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

148 (!!!!! 1068.115234375): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

150 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

151 (380.9928894043): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794069 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794069 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (37.193298339844): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

153 (29.087066650391): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

154 (31.948089599609): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

156 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794069 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794069 AND published='1' LIMIT 1

157 (50.067901611328): select jos_twitters.link from jos_twitters where cat=10

158 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

159 (27.894973754883): select jos_google_plus.link from jos_google_plus where cat=10

160 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

161 (259.8762512207): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1180.88722229): insert into jos_banners_delta values (14615,'2025-04-30 21:43:37','3.139.59.149','view'),(14202,'2025-04-30 21:43:37','3.139.59.149','view'),(14203,'2025-04-30 21:43:37','3.139.59.149','view')

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