Extensive lymphadenectomy in colorectal cancer with isolated para‐aortic lymph node metastasis below the level of renal vessels

Choi, Pyong Wha; Kim, Hee Cheol; Kim, Ah Young; Jung, Sang Hun; Yu, Chang Sik; Kim, Jin Cheon

doi:10.1002/jso.21421

Cited by 92 publications

(138 citation statements)

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“…It is also well known that patients with isolated PALN metastasis were found to be very rare in the range 1.0-1.3% [15,16] , and a majority of PALN metastasis accompanied other distant sites of metastasis, such as the liver, lung, extraabdominal LNs, or peritoneal dissemination. Therefore, systemic chemotherapy was generally indicated for patients with PALN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Min et al [15] evaluated the outcome of 38 patients with metachronous-isolated PALN metastasis and reported that the median OS in the PALND group (n = 6) was 34 months, which was significantly better than 14 months in the non-resected group (n = 34; p = 0.034). Choi et al [16] reported the outcome of 77 patients after PALND for metachronous-isolated PALN metastasis. Five-year OS and the median OS in the PALND group (n = 24) were 53.5% and 64 months, which were significantly better compared with the non-resected group (n = 53) (12% and 33 months, respectively) [16] .…”

Section: Discussionmentioning

confidence: 99%

“…Choi et al [16] reported the outcome of 77 patients after PALND for metachronous-isolated PALN metastasis. Five-year OS and the median OS in the PALND group (n = 24) were 53.5% and 64 months, which were significantly better compared with the non-resected group (n = 53) (12% and 33 months, respectively) [16] . In our study, all patients (n = 5) with metachronous PALN metastasis were alive during the study period (their median follow-up period was 44.1 months), and supported these results.…”

Section: Discussionmentioning

confidence: 99%

“…However, surprisingly, there are no large reports to show the past cruel results of PALND. Moreover, the clinical significance of PALND in the current era of modern chemotherapy has not been fully discussed [14][15][16] . In this study, we evaluated retrospectively the clinical significance of PALND for advanced or metastatic colorectal cancer in the current era of modern chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

et al. 2015

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Background/Aims: Surgical resection is not generally indicated for para-aortic lymph node (PALN) metastasis from colorectal cancer. However, the clinical significance of PALN dissection (PALND) in the current era of modern chemotherapy has not been fully discussed. Methods: Between November 2006 and February 2013, 14 patients underwent PALND for colorectal cancer and were proven as having pathological PALN metastasis. The median follow-up was 33.2 months. Results: Primary location was the right-colon in 2 patients, and the left-colon or rectum in 12 patients. The timing of metastasis was metachronous in 5 patients and synchronous in 9 patients. Eleven patients (79%) received perioperative aggressive modern chemotherapy. Neoadjuvant chemotherapy with targeted drugs was introduced in 9 patients (64%) and 6 patients received adjuvant chemotherapy. Recurrence after PALND occurred in 12 patients (86%). The most common site was the lung in 6 patients (43%). The 1- and 3-year disease-free survivals were 39.3 and 7.9%, respectively. The 3-year overall survival were 41.2%. Conclusion: The recurrence rate after PALND for strictly selected patients was quite high even in the current era of modern chemotherapy. However, some patients achieved long-term survival or could be cured. Therefore, we should re-evaluate the efficacy of PALND in a larger prospective study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

et al. 2015

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“…However, in rectal cancer, clinical significance of extended lymph node dissection in the paraaortic region has not been well addressed. To the best of our knowledge, few clinical studies have been performed on the outcome of extensive lymphadenectomy in colorectal cancer (CRC) with isolated PAN metastasis [13]. To date, no study was designed to assess the efficacy of paraaortic lymphadenectomy in rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

The Role of Para-Aortic Lymphadenectomy in Surgical Management of Patients with Stage N+ Rectal Cancer Below the Peritoneal Reflection

Liu

Wang

Yang

et al. 2011

Cell Biochem Biophys

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The goal of this retrospective study was to determine the effect of para-aortic lymphadenectomy on clinical outcome in patients with stage N+ rectal adenocarcinoma below the peritoneal reflection. A retrospective analysis was performed on the clinical outcome of 181 patients with stage N+ rectal adenocarcinoma below the peritoneal reflection who underwent total mesorectal excision (TME) with total pelvic lymph node (PLN) adenectomy, with or without para-aortic lymph node (PAN) adenectomy. Independent prognostic factors were determined by multivariate Cox regression analysis. Disease-free survival (DFS) was analyzed using Kaplan-Meier curves and the log-rank test. The incidence of PLN metastases was 39.2% (71/181) in all the patients, and the incidence of PAN metastases was 12% (12/100) in patients who received PLN + PAN adenectomies. The patients were divided into two groups: PLN adenectomy (n = 81) and PLN + PAN adenectomy (n = 100). There were no statistically significant differences in clinicopathological factors between the PLN adenectomy and PLN + PAN adenectomy groups. On univariate analysis, the gross tumor type (P = 0.012), histological differentiation (P = 0.013), CEA level (P = 0.019), T stage (P = 0.019), N stage (P < 0.0001), and the number of positive PLN sites (P < 0.0001) were associated with poor DFS. Gross tumor type (P = 0.031), N stage (P = 0.001), and the number of positive PLN sites (P < 0.0001) were independent prognostic factors for DFS as identified by multivariate Cox regression analysis. PLN + PAN adenectomy significantly improved DFS compared to PLN adenectomy alone in patients with noninfiltrating type (P = 0.001), but not in patients with infiltrating type (P = 0.075). PLN + PAN adenectomy significantly improved DFS compared to PLN adenectomy alone in patients with 0 or 1 positive PLN site (P = 0.001, P = 0.009 respectively), but not in patients with ≥2 positive PLN sites (P = 0.095). In the N1 and N2 stage groups, PLN + PAN adenectomy significantly improved DFS compared with PLN adenectomy alone (P = 0.001; P < 0.0001, respectively). Furthermore, mean DFS was longer in the absence of PAN metastasis (P < 0.0001). PAN metastases appear to be associated with reduced DFS. Total PAN adenectomy may improve DFS in patients with noninfiltrating type, stage III rectal cancer below the peritoneal reflection, who have <2 positive PLN sites.

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A “conversion‐deterioration‐double mutation” theory for the evolution and progression of colorectal cancer

Wang

Yan

2022

Cancer Medicine

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In this study, based on some clinical phenomena and recently published knowledge, we proposed our “conversion‐deterioration‐double mutation” theory, which provides a possible unifying explanation for the evolutionary process of colorectal cancer cells in the human body. In this theory, we proposed that there is a partial interconversion and a jump conversion relationship among normal colorectal epithelial cells, colorectal cancer cells, stem cells, and cancer stem cells (conversion). This conversion leads to tumor heterogeneity. We also proposed that well‐differentiated cancer cells converted from cancer stem cells have a more aggressive pattern than primary cancer cells (deterioration). The deterioration of primary cancer cells leads to differences in treatment responses and prognosis. Finally, we speculate a double mutation theory, indicating that for metastasis to occur, both mutations of cancer cells and mutations of target organs are needed and should match and meet. All these three points constitute the “conversion‐deterioration‐double mutation” theory.

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Extensive lymphadenectomy in colorectal cancer with isolated para‐aortic lymph node metastasis below the level of renal vessels

Abstract: The findings of this study suggest that PALN dissection increases the survival of patients with isolated PALN metastasis from CRC, and that it has a tolerable morbidity rate.

Cited by 92 publications

References 18 publications

Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

The Role of Para-Aortic Lymphadenectomy in Surgical Management of Patients with Stage N+ Rectal Cancer Below the Peritoneal Reflection

A “conversion‐deterioration‐double mutation” theory for the evolution and progression of colorectal cancer

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