P105 - Is Total Neoadjuvant Therapy the solution for lateral pelvic lymph nodes in rectal cancer? A retrospective analysis.

Saturday, May 10, 2025

2:20 PM – 2:28 PM PT

Location: Ballroom 6B, Upper Level

Abstract Podium Presenter(s)

MN

MITHUN NARIAMPALLI KARTHYARTH, MBBS, MS, DNB, MCH

FELLOW
DIVISION OF COLORECTAL SURGERY, DEPARTMENT OF SURGICAL ONCOLOGY, TATA MEMORIAL HOSPITAL, MUMBAI< MAHARASHTRA, INDIA
MUMBAI, Maharashtra, India

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

Author(s)

SUBHATHIRA MANOHKARAN, MS

General surgeon and collorectal fellow
Tata Memorial Cancer Centre
Mumbai,, Maharashtra, India

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Akash Mor, MS, MCh

Trainee, Division of Colorectal Surgery , Department of Surgical oncology
Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai , India
Aurangabad, Maharashtra, India

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

ABHISHEK GANGULY, MBBS, MS

SENIOR RESIDENT
TATA MEMORIAL HOSPITAL, MUMBAI
MUMBAI, Maharashtra, India

Disclosure information not submitted.
AS

ANKIT SHARMA, MBBS, MS, MCH

ASSISTANT PROFESSOR
TATA MEMORIAL HOSPITAL, MUMBAI
Tata Memorial Hospital, Mumbai
MUMBAI, Maharashtra, India

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

MUFADDAL K. KAZI, MBBS, MS, MCH

Associate Professor
Tata memorial hospital, Mumbai
Mumbai, Maharashtra, India

Disclosure information not submitted.
AD

ASHWIN DESOUZA, MBBS, MS, MCh

Professor
Tata Memorial Center, Mumbai
Mumbai, Maharashtra, India

Disclosure information not submitted.

Senior Author(s)

Avanish P. Saklani, Tata memorial Hospital, Homi Bhabha National Institute, Mumbai

Professor
Division of colorectal Surgeon, Department of Surgical oncology
Tata Memorial hospital , Mumbai
Mumbai, Maharashtra, India

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

Submitting Author(s)

MN

MITHUN NARIAMPALLI KARTHYARTH, MBBS, MS, DNB, MCH

FELLOW
DIVISION OF COLORECTAL SURGERY, DEPARTMENT OF SURGICAL ONCOLOGY, TATA MEMORIAL HOSPITAL, MUMBAI< MAHARASHTRA, INDIA
MUMBAI, Maharashtra, India

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

All of the relevant financial relationships listed below have been mitigated.

MITHUN NARIAMPALLI KARTHYARTH, MBBS, MS, DNB, MCH: This individual has no financial relationships with ineligible companies.

SUBHATHIRA MANOHKARAN, MS: This individual has no financial relationships with ineligible companies.

Akash Mor, MS, MCh: This individual has no financial relationships with ineligible companies.

ANKIT SHARMA, MBBS, MS, MCH: This individual has no financial relationships with ineligible companies.

Avanish P. Saklani, Tata memorial Hospital, Homi Bhabha National Institute, Mumbai: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Lateral pelvic lymph node (LLN) involvement occurs in 10%–25% of rectal cancer cases. Selective lateral pelvic node dissection (PLND) after chemoradiation for persistent node is the standard of care. Authors of the OPRA trial analyzed LLN involvement in the trial patients and found that only 3.5% of patients with lateral pelvic nodes developed local recurrence, all of whom also had associated distant metastasis. They suggested that total neoadjuvant therapy (TNT) can adequately manage lateral pelvic nodes potentially eliminating the need of PLND. Our aim is to evaluate the role of TNT to avoid PLND . In addition we aim to identify risk factors that can predict positive LLN in patients of rectal cancer undergoing PLND.

Methods/Interventions: All consecutive patients undergoing LPLND for locally advanced rectal cancer (LARC) from January 2014 to July 2024 were included. Patients with LLN >7 mm at presentation and with persistent LLN >4 mm on restaging MRI after neoadjuvant therapy underwent PLND. Risk factors for pLLN were analyzed using multivariable analysis.

Results/Outcomes: Among 228 patients who underwent LPLND, 57 (25%) had pathologically positive lateral pelvic lymph nodes (pLLN). The internal iliac region was the most common site for lateral nodes, identified in 108 patients (47%). The median lymph node size before neoadjuvant therapy was 10 mm. Total neoadjuvant therapy (TNT) was administered to 118 patients (52%), with 30 (25.4%) showing positive LLN after TNT. In a multivariable logistic regression analysis for risk factors predicting lateral pelvic lymph node positivity, cT4b stage compared to cT3 (OR 2.640, 95% CI 1.215–5.73, p=0.014) and multiple stations of enlarged LLN compared to the internal iliac lymph node (OR 3.914, 95% CI 1.283–11.939, p=0.016) were predictive of pLLN. TNT was not associated with pLLN (OR 2.976, 95% CI 0.405–21.882, p=0.284)

Conclusion/Discussion: Lateral pelvic node dissection should be done in patients with persistently enlarged lymph nodes after total neoadjuvant therapy.