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Session: Abstract Session: Rectal and Colon Cancer

P201 - Impact of MRI-Diagnosed Lateral Lymph Nodes on Survival and Recurrence in Rectal Cancer: A Nationwide Cohort Study

Sunday, May 11, 2025
12:43 PM – 12:49 PM PT
Location: Ballroom 6B, Upper Level

    Author(s)

  • Erik Agger, PhD, FEBS(colo) (he/him/his)

    Senior consultant surgeon
    Skåne University Hospital, Lund University
    Malmö, Skane Lan, Sweden

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

  • CD

    Cédric Delorme, n/a

    medical student
    Lund University
    Malmo, Skane Lan, Sweden

    Disclosure information not submitted.

    • Abstract Podium Presenter(s)

  • Erik Agger, PhD, FEBS(colo) (he/him/his)

    Senior consultant surgeon
    Skåne University Hospital, Lund University
    Malmö, Skane Lan, Sweden

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

    • Submitting Author(s)

  • Erik Agger, PhD, FEBS(colo) (he/him/his)

    Senior consultant surgeon
    Skåne University Hospital, Lund University
    Malmö, Skane Lan, Sweden

    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.
Erik Agger, PhD, FEBS(colo): This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Management of lateral lymph node metastases (LLNM) in rectal cancer continues to be a topic of debate within the colorectal community. LLNM remains a significant contributor to local recurrence (LR) in advanced rectal cancer. Treatment options for LLNM include neoadjuvant therapy and/or surgical removal of affected nodes, with the approach largely guided by radiological diagnostics. This study aimed to investigate the impact of LLNM, as diagnosed by MRI, on LR and overall survival (OS) in patients with rectal cancer.

Methods/Interventions: A retrospective cohort study was conducted involving 2,869 patients diagnosed with rectal cancer 2017-2021. After excluding cases with non-radical resections, early recurrences, and various registration errors, 2,779 patients were analysed. Patients were grouped based on MRI findings of LLNM. Outcome measures were LR at 3 years and OS at 3 and 5 years.

Results/Outcomes: Radiological assessments identified 90.6% (n=2518/2779) patients having negative lateral lymph nodes (LLN) and 9.4% (n=261/2779) as having positive LLN.
In univariable analysis, HR for LR at 3 years was increased to 2.79 (1.55-5.03, p= < 0.001) among LLN-positive patients. In multivariable analysis, adjusted for gender, age, cStage, neoadjuvant therapy, ASA-class and tumor height, this remained HR 1.97 (1.04-3.73, p=0.037) remained. When lateral lymph node dissection (LLND) was added to the adjustment variables, the difference was no longer significant HR 1.19 (0.55-2.56, p=0.655).
No significant differences in OS were observed at 3 years in either uni- or multivariable analyses. At 5 years, univariable analysis indicated increased mortality in LLN-positive patients (HR 1.64 (1.24-2.17, p< 0.001). In multivariable analysis, adjusting for the same variables as above, no difference in OS was noted without LLND adjustment (HR 1.32 ( 0.97-1.80, p=0.075) and with LLND adjustment (HR 1.29 (0.93-1.79, p=0.135).

Conclusion/Discussion: The radiological diagnosis of LLNM during clinical work-up is a poor prognostic factor overall and associated with other unfavourable prognostic factors. Our findings suggest that selective LLND following neoadjuvant treatment may reduce the risk of LR. Further research is needed to optimize treatment strategies for patients with LLNM to improve outcomes.