Title: Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer
and control of lateral lymph node metastasis
Version: 1 Date: 04 May 2022
Reviewer's report:
The aim of this systematic review was to evaluate the different surgical approach to rectal cancer
in Japan compared to western countries. Nowadays we don’t have an affordable tool capabe
to predict lateral lymph node swelling that can be managed by neoadjuvant chemoradiotherapy
(nCRT). So, in this study the authors want to assess characteristics of the lateral lymph node
recurrence (LLNR) and LLND (lateral lymph node dissection) that can be managed by nCRT.
Furthermore, no established criteria for lateral lymph node dissection indication were proposed
in current literature.
Interestingly,it is clinically significant if we can distinguish the lymph nodes which require
LLND from the lymph nodes which can avoid LLND by nCRT. Previous studies have not yet
assessed factors for LLND indication beside size of the lymph node.
The authors, beside the lateral lymph node size, considered neutrophil/lymphocyte NLR,
platelet/lymphocyte (PLR), CEA, tumor shrinkage rate, tumour regression grade (TRG) and
laterl lymph node short axis as predictors factors capable to conduct a correct indication for
LLND.
168 patients with low rectal cancer (cT3-T4, any N) were scheduled for nCRT and TME without
LLND.
Lateral lymph node short axis was measured using MRI.
Statistical analysis and results assessment methodology were both correct. A median
observational period of 1.874 days is oncological correct.
The authors have reported these results: pre- and post-CRT CEA levels were not statistically
related with lateral lymph node recurrence; significant statistical relations between pre- and post-
CRT PLR and lateral lymph node recurrence; no statistical relation between tumor regression
rate and lateral lymph node recurrence; statistically significant relations between pre- or post-
CRT and lateral lymph node short-axis diameter.
The authors suggests that the histological effect of rectal lesions by CRT does not support the
omission of LLND. And the minor axis of the lateral lymph node and PLR are risk factors for
recurrence of the lateral lymph node.
Beyond the limitations of the study (single center experience, small sample size), in the current
study is the first in which lateral lymph node recurrence was evaluated by various factors not
limited to only lymph node size.
The short axis diameters taken into consideration seems to be a feasible and easy to use in clinical
and surgical management of low rectal cancers (pre and post nCRT).
I think that the authors could make more clear the relationship between lateral lymph node
dissection, lateral lymph node recurrence and local recurrence.
Tables and Figures are well structured.
The lack of randomized trials makes it impossible to draw strenght conclusions.
Title: Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer
and control of lateral lymph node metastasis
Version: 1 Date: 04 May 2022
Reviewer's report:
The aim of this systematic review was to evaluate the different surgical approach to rectal cancer
in Japan compared to western countries. Nowadays we don’t have an affordable tool capabe
to predict lateral lymph node swelling that can be managed by neoadjuvant chemoradiotherapy
(nCRT). So, in this study the authors want to assess characteristics of the lateral lymph node
recurrence (LLNR) and LLND (lateral lymph node dissection) that can be managed by nCRT.
Furthermore, no established criteria for lateral lymph node dissection indication were proposed
in current literature.
Interestingly,it is clinically significant if we can distinguish the lymph nodes which require
LLND from the lymph nodes which can avoid LLND by nCRT. Previous studies have not yet
assessed factors for LLND indication beside size of the lymph node.
The authors, beside the lateral lymph node size, considered neutrophil/lymphocyte NLR,
platelet/lymphocyte (PLR), CEA, tumor shrinkage rate, tumour regression grade (TRG) and
laterl lymph node short axis as predictors factors capable to conduct a correct indication for
LLND.
168 patients with low rectal cancer (cT3-T4, any N) were scheduled for nCRT and TME without
LLND.
Lateral lymph node short axis was measured using MRI.
Statistical analysis and results assessment methodology were both correct. A median
observational period of 1.874 days is oncological correct.
The authors have reported these results: pre- and post-CRT CEA levels were not statistically
related with lateral lymph node recurrence; significant statistical relations between pre- and post-
CRT PLR and lateral lymph node recurrence; no statistical relation between tumor regression
rate and lateral lymph node recurrence; statistically significant relations between pre- or post-
CRT and lateral lymph node short-axis diameter.
The authors suggests that the histological effect of rectal lesions by CRT does not support the
omission of LLND. And the minor axis of the lateral lymph node and PLR are risk factors for
recurrence of the lateral lymph node.
Beyond the limitations of the study (single center experience, small sample size), in the current
study is the first in which lateral lymph node recurrence was evaluated by various factors not
limited to only lymph node size.
The short axis diameters taken into consideration seems to be a feasible and easy to use in clinical
and surgical management of low rectal cancers (pre and post nCRT).
I think that the authors could make more clear the relationship between lateral lymph node
dissection, lateral lymph node recurrence and local recurrence.
Tables and Figures are well structured.
The lack of randomized trials makes it impossible to draw strenght conclusions.
Please review this paper.
user
Title: Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer
and control of lateral lymph node metastasis
Version: 1 Date: 04 May 2022
Reviewer's report:
The aim of this systematic review was to evaluate the different surgical approach to rectal cancer
in Japan compared to western countries. Nowadays we don’t have an affordable tool capabe
to predict lateral lymph node swelling that can be managed by neoadjuvant chemoradiotherapy
(nCRT). So, in this study the authors want to assess characteristics of the lateral lymph node
recurrence (LLNR) and LLND (lateral lymph node dissection) that can be managed by nCRT.
Furthermore, no established criteria for lateral lymph node dissection indication were proposed
in current literature.
Interestingly,it is clinically significant if we can distinguish the lymph nodes which require
LLND from the lymph nodes which can avoid LLND by nCRT. Previous studies have not yet
assessed factors for LLND indication beside size of the lymph node.
The authors, beside the lateral lymph node size, considered neutrophil/lymphocyte NLR,
platelet/lymphocyte (PLR), CEA, tumor shrinkage rate, tumour regression grade (TRG) and
laterl lymph node short axis as predictors factors capable to conduct a correct indication for
LLND.
168 patients with low rectal cancer (cT3-T4, any N) were scheduled for nCRT and TME without
LLND.
Lateral lymph node short axis was measured using MRI.
Statistical analysis and results assessment methodology were both correct. A median
observational period of 1.874 days is oncological correct.
The authors have reported these results: pre- and post-CRT CEA levels were not statistically
related with lateral lymph node recurrence; significant statistical relations between pre- and post-
CRT PLR and lateral lymph node recurrence; no statistical relation between tumor regression
rate and lateral lymph node recurrence; statistically significant relations between pre- or post-
CRT and lateral lymph node short-axis diameter.
The authors suggests that the histological effect of rectal lesions by CRT does not support the
omission of LLND. And the minor axis of the lateral lymph node and PLR are risk factors for
recurrence of the lateral lymph node.
Beyond the limitations of the study (single center experience, small sample size), in the current
study is the first in which lateral lymph node recurrence was evaluated by various factors not
limited to only lymph node size.
The short axis diameters taken into consideration seems to be a feasible and easy to use in clinical
and surgical management of low rectal cancers (pre and post nCRT).
I think that the authors could make more clear the relationship between lateral lymph node
dissection, lateral lymph node recurrence and local recurrence.
Tables and Figures are well structured.
The lack of randomized trials makes it impossible to draw strenght conclusions.
assistant