Improving Selection for Resection of Synchronous Para-Aortic Lymph Node Metastases in Colorectal Cancer

Yamada, K; Tsukamoto, Shunsuke; Ochiai, Hiroki; Shida, Dai; Kanemitsu, Yukihide

doi:10.1159/000491100

Cited by 35 publications

(51 citation statements)

References 34 publications

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“…In regards to other prognostic factors, distant metastasis and PALND did not have signi cant differences. However, the M1b/M1c patient did not achieve long survival, and distant metastasis has potential as a prognostic factor [4,14]. Though PALND was a statistically negative prognostic factor, it should be performed, if possible, because one patient after lymphadenectomy developed PALN recurrence and additional PALND provided long-term survival.…”

Section: Discussionmentioning

confidence: 98%

“…In colorectal cancer (CRC), the relatively rare occurrence of metastatic para-aortic lymph node (PALN) is categorized as stage IV disease [1,2]. The reported incidence of isolated metastatic PALN is 1-2% [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Bae et al [12] also demonstrated that PALND results in survival rates comparable to synchronous liver metastasectomy. However, although the 5-year overall survival (OS) rates for patients who underwent synchronous PALND reached 25-53%, approximately 80% of the patients experience recurrence [4,[12][13][14][15] and few studies have discussed the recurrence pattern [12] or treatment after recurrence. Furthermore, no de nitive perioperative chemotherapy has been established.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, three retrospective studies have shown updated prognostic factors for synchronous PALND, including R0 resection, histological type, number of PALN, other distant metastases, metastatic lateral pelvic lymph node, and preoperative CEA values [4,15,16]. However, the prognostic factors for synchronous PALND identi ed in the previous studies are not yet universal.…”

Section: Introductionmentioning

confidence: 99%

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The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Ushigome

Yasui

Ohue

et al. 2020

Preprint

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Background: Synchronous metastatic para-aortic lymph node (mPALN) dissectionin colorectal cancer has relatively good oncological outcomes, though many patients develop recurrence. Universal prognostic factor remain unclear and no definitive perioperative chemotherapy is available, making the treatment of mPALN controversial. In the present study, we aimed to establish a treatment strategy for synchronous mPALN.Methods: This retrospective study involved 20 patients with pathological mPALN below the renal vein who underwent R0 resection. Long-term outcomes, recurrence type, and prognostic factors for survival were investigated.Results: The 5-year overall survival and recurrence-free survival rates were 39% and 25%, respectively. Seventeen patients (85%) developed recurrence, including 13 (76%) within 1 year after surgery, and ~70% of all recurrences were multiple recurrences. Four patients (20%) survived >5 years. Pathological T stage (p=0.011), time to recurrence (p=0.007), and recurrence resection (p=0.009) were identified as prognostic factors for long-term survival.Conclusions: R0 resection of synchronous mPALN in colorectal cancer resulted in acceptable oncological outcomes, though we found a high rate of early unresectable recurrence. If the recurrence occurs late or isolated, surgical resection should be considered for longer survival.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Ushigome

Yasui

Ohue

et al. 2020

Preprint

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“…In the present study, postoperative morbidity occurred in 31.0% of patients, which was comparable with that of other studies (7.8-38.9%). [10][11][12][13][14] The main morbidity was surgical site infection, and the rate of Clavien and Dindo classification grade Ⅲ or above was only 10.3%, with no perioperative death. These results suggest that the incidence of postoperative morbidities associated with PALN dissection is within acceptable limits.…”

Section: Discussionmentioning

confidence: 99%

Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer

Sakamoto

Ozawa

Nakanishi

et al. 2020

Preprint

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Background The optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer.Methods Between January 1986 and August 2016, 29 patients with pathologically positive PALN metastasis who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in patients with PALN metastasis.Results The 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. Six (20.7%) patients experienced no recurrence in the three years after surgery. Postoperative complications were seen in nine (31.0%) patients. The three-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032).Conclusions PALN dissection for left-sided colon or rectal cancer with synchronous PALN metastasis can be a feasible treatment option in selected patients.

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Para‐aortic lymph node dissection in left‐sided colorectal cancer: Risk factors, prognostic impact, and therapeutic value

Sun

Deng

Zhong

et al. 2022

Journal of Surgical Oncology

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Aim: This study aimed to clarify risk factors, prognostic impact, and the therapeutic value of para-aortic lymph node (PALN) dissection in left-sided colorectal cancer.Method: One hundred and fifty-four patients who underwent primary tumor resection and PALN dissection for left-sided colorectal cancer were included.Logistic regression analysis was used to identify risk factors for PALN metastasis. Cox regression analysis was performed to identify risk factors for overall survival (OS).Results: PALN metastasis was pathologically confirmed in 47 patients (30.5%).Postoperative complications occurred in 42 patients (27.3%). Pathological N stage (OR = 4.661, p = 0.034) and inferior mesenteric artery LNs metastasis (OR = 6.048, p = 0.003) remained to be independently associated with PALN metastasis, the 5-year OS rate and median survival in patients with PALN metastasis was 37.7% and 24 months. Elevated preoperative serum CA19-9 level (HR = 1.006, p = 0.007), number of positive LNs > 7 (HR = 7.263, p = 0.001), and mucinous adenocarcinoma or signet ring cell carcinoma (HR = 6.511, p = 0.001) were independently associated with OS in patients with PALN metastasis. Conclusion:PALN dissection in addition to primary tumor resection have acceptable postoperative complications and may be oncologically beneficial in selected left-sided colorectal cancer patients with clinically suspicious PALN metastasis.

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Improving Selection for Resection of Synchronous Para-Aortic Lymph Node Metastases in Colorectal Cancer

Abstract: PALN dissection below the renal veins for patients with isolated PALN metastasis with 2 or fewer involved PALNs may be effective in improving prognosis in colorectal cancer.

Cited by 35 publications

References 34 publications

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer

Para‐aortic lymph node dissection in left‐sided colorectal cancer: Risk factors, prognostic impact, and therapeutic value

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