INTRODUCTIONThe treatment strategies for rectal cancer have been gradually developed in the recent past. In addition to the establishment of the surgical concept called “total mesorectal excision,” neoadjuvant chemoradiation (CRT) was introduced to reduce the incidence of local recurrence after rectal cancer surgery. Accordingly, recent guidelines recommend neoadjuvant CRT followed by radical surgery as a standard management protocol in locally advanced rectal cancer. The drawback is that the tumor‐node‐metastasis (TNM) staging system of colorectal cancer is commonly used in rectal cancer after neoadjuvant CRT, which does not accurately reflect prognosis influenced by radiotherapy. The prognostic impact of pathologic stage in rectal cancer differs according to the administration of neoadjuvant CRT. Particularly, neoadjuvant CRT affects the number and status of the lymph nodes, which might change the prognostic significance of ypN stage. Therefore, for accurate staging after neoadjuvant CRT, a distinctive staging system is needed in rectal cancer.Currently, the distribution of lymph node metastasis (LND) is not taken into consideration in determining TNM staging. LND has been studied as a prognostic factor in colorectal cancer, although the results were debatable. Considering that the radiation field is generally below the sacral promontory level, the impact of CRT on lymph nodes may
Journal of Surgical Oncology – Wiley
Published: Jan 1, 2018
Keywords: ; ; ; ;
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