Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes

Song, Seung Ho; Park, Soo Yeun; Park, Jun Seok; Kim, Hye Jin; Yang, Chun‐Seok; Choi, Gyu–Seog

doi:10.4174/astr.2016.90.1.29

Cited by 32 publications

(75 citation statements)

References 19 publications

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“…Nevertheless, despite recent advances in diagnostic imaging, it remains difficult to diagnose PALN metastases before surgery. It has been reported that approximately 60% of patients with a preoperative diagnosis of PALN metastasis who underwent para‐aortic lymphadenectomy were not diagnosed with pathological PALN metastasis . Primary resection is obviously the best primary treatment for patients without PALN metastasis, and given the present study’s favorable outcomes, it is reasonable to consider primary resection and laparoscopic para‐aortic lymphadenectomy for suspected isolated PALN metastasis from CRC.…”

Section: Discussionmentioning

confidence: 80%

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Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis

Yamamoto

Kanai

et al. 2018

Asian J Endoscop Surgery

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Introduction The optimal surgical management strategy for isolated para‐aortic lymph node (PALN) metastases from colorectal cancer (CRC) remains unclear. However, the complication rates for open approaches remain high. In this study, the outcomes of laparoscopic para‐aortic lymphadenectomy in patients with clinically suspected PALN metastasis were evaluated. Methods Between April 2013 and April 2018, we performed laparoscopic primary resection and para‐aortic lymphadenectomy in 11 patients with advanced colorectal cancer and clinically suspected PALN metastasis. This study was a single‐center, retrospective, case series analysis, and the surgical outcomes were reviewed. Results There were no cases of perioperative mortality, and conversion to open surgery was necessary in only one patient (9%) because of invasion into a rib. One patient (9%) required a blood transfusion. Postoperative complications occurred in three patients, and the morbidity rate was 27% (3/11). Pathologically, PALN metastasis was confirmed in five patients (45%), all of whom received postoperative chemotherapy. The median survival time for all patients was 25 months, and one patient died of recurrence at 25 months after the initial surgery. Two other patients were alive with recurrence after 47 and 36 months, and two patients were alive without recurrence after 17 and 2 months. Conclusion Laparoscopic para‐aortic lymphadenectomy for advanced colorectal cancer with clinically suspected PALN is technically feasible and may be beneficial in selected patients. It is necessary to investigate the feasibility of this procedure in a future case series, and information regarding true oncologic outcome will require long‐term follow‐up.

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Section: Discussionmentioning

confidence: 80%

“…For patients with primary CRC and clinically suspected PALN metastasis who undergo para-aortic lymphadenectomy, open approaches are generally selected, and there have been very few reports about the use of laparoscopic approaches (4,5,9,10). The complication rates for open approaches remain high (range, 25%-50%) (4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis

Yamamoto

Kanai

et al. 2018

Asian J Endoscop Surgery

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“…The 5-year survival rate is > 95% in rectal cancer patients without LN metastasis, but decreases to 50~ 70% in patients with LN metastasis [ 3 ]. Additionally, the LN stage of rectal cancer is one of the most important determining factors for adjuvant chemotherapy and extended LN dissection [ 21 , 22 ]. The procedure of choice for rectal cancer patients with a clinical stage of N0 or N1 is total mesorectal excision, which is surgical excision of the mesorectal fat, including all LNs.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of F-18 FDG PET/CT with optimal cut-offs of maximum standardized uptake value according to size for diagnosis of regional lymph node metastasis in patients with rectal cancer

et al. 2018

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BackgroundThe low sensitivity of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of metastatic lymph nodes (LNs) is mainly due to the partial volume effect in patients with rectal cancer. This retrospective study evaluated the diagnostic accuracy of F-18 FDG PET/CT with optimal cut-off values of the maximum standardized uptake value (SUVmax), according to LN size, for the evaluation of regional LN in rectal cancer patients.MethodsThis study included 176 patients with rectal cancer who underwent F-18 FDG PET/CT for initial staging. Patients were classified based on the long-axis diameter of the regional LN on CT images as small (≤ 7 mm; n = 118) and large (> 7 mm; n = 58) LN groups. The optimal cut-off value of SUVmax was determined for each group, using receiver operating characteristic curve analysis. Areas under the curve (AUC) were compared by C-statistics using two methods: the cut-off value of SUVmax optimized according to LN size, and a fixed SUVmax cut-off value of 2.5.ResultsThe optimal cut-off values of SUVmax for the small and large LN groups were 1.1, and 2.1, respectively. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the optimal cut-off values were 90.6, 70.9, and 76.3% in the small LN group, and 68.6, 78.3, and 72.4% in the large LN group. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the fixed cut-off value were 18.8, 100, and 78.0% in the small LN group, and 51.4, 87.0, and 65.5% in the large LN group. The AUC was significantly higher using the optimal cut-off values than the fixed cut-off value (0.808 vs. 0.594, p = 0.005) in the small LN group, but not in the large LN group (0.734 vs. 0.692, p = 0.429).ConclusionsApplication of the lower cut-off value of SUVmax improves the diagnostic performance of F-18 FDG PET/CT for the evaluation of small regional LNs in patients with rectal cancer.Electronic supplementary materialThe online version of this article (10.1186/s40644-018-0165-5) contains supplementary material, which is available to authorized users.

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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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Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes

Cited by 32 publications

References 19 publications

Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis

Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis

Accuracy of F-18 FDG PET/CT with optimal cut-offs of maximum standardized uptake value according to size for diagnosis of regional lymph node metastasis in patients with rectal cancer

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

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