Management of isolated para-aortic lymph node recurrence after surgery for colorectal cancer

Abstract

The rare incidence of isolated para-aortic lymph node (PALN) recurrence of colorectal cancer has precluded the formulation of treatment guidelines. This study evaluated and compared the effects of different treatment modalities on survival outcomes in patients with PALN recurrence. Methods: Patients diagnosed with isolated PALN recurrence after curative resection for primary colorectal cancer from January 2004 to December 2014 were evaluated retrospectively. Patients with isolated recurrence were selected using imaging modalities. Overall survival (OS) and survival after recurrence (SAR) were analyzed and compared between different treatments using the Kaplan-Meier method. Results: The median OS was 64 months with a median follow-up time of 50 months. Of the 46 patients with PALN recurrence, 35 (76.1%) had isolated recurrences. Of these 35 patients, 16 underwent PALN resection and 19 received chemotherapy. Median SAR was significantly longer in patients who did than did not undergo resection (71 months vs. 39 months, P = 0.017). Median OS tended to be longer in patients who did than did not undergo resection (77 months vs. 62 months, P = 0.055). SAR was similar in patients who received radiotherapy and those who underwent resection (34 months vs. 46 months, P = 0.146). Three of 16 patients (18.8%) who underwent resection were found to be recurrence-free. Conclusion: Surgical resection of isolated PALN recurrence may benefit patients, with favorable survival outcomes and by providing definitive diagnosis for proper treatment planning.

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

“…After ruling out 277 duplicate publications, a further analysis involved 453 studies, out of which 406 were considered to not be relevant for titles and abstracts, while 47 full-text articles were assessed for eligibility. After removing 38 studies that did not comply with the inclusion criteria, nine studies (all retrospective, most of them being of good quality, see Supplementary material-Table S1) underwent qualitative synthesis [5,[10][11][12][13][14][15][16][17].…”

“…Table 1 shows demographic features of the populations under analysis. The nine articles included covered the time period of 1988-2018, gathering a total of 161 patients [5,[10][11][12][13][14][15][16][17]. Male prevalence (82/146 = 56.2%; 7 out of 9 studies) was recorded in addition to a 55.5-63 year median age [5,[10][11][12][13][14][15][16][17].…”

“…The nine articles included covered the time period of 1988-2018, gathering a total of 161 patients [5,[10][11][12][13][14][15][16][17]. Male prevalence (82/146 = 56.2%; 7 out of 9 studies) was recorded in addition to a 55.5-63 year median age [5,[10][11][12][13][14][15][16][17]. At presentation, most primary CRCs were located in the colon (108/146 = 74%; 7 out of 9 studies) [5,[10][11][12][13][14][15][16][17].…”

“…Male prevalence (82/146 = 56.2%; 7 out of 9 studies) was recorded in addition to a 55.5-63 year median age [5,[10][11][12][13][14][15][16][17]. At presentation, most primary CRCs were located in the colon (108/146 = 74%; 7 out of 9 studies) [5,[10][11][12][13][14][15][16][17]. Almost all patients underwent adjuvant chemotherapy for PALNM (134/151 = 88.7%; 8 studies out of 9 ones) [5,[10][11][12][13][14][15][16][17].…”

Surgical Roles in the Management of Metachronus Para-aortic Lymph Node Recurrence and Synchronous Para-aortic Lymph Node Metastasis in Colorectal Cancer Patients

“…In the present report, we have overcome certain weaknesses of previous studies: 1 12 first, the present was a prospective study, which enabled better data collection and analysis to reach accurate results; second, we included patients with SPM and MPR to verify the role of PALND whether it was done during resection of the primary tumor or resection of isolated PALN recurrence; third, we compared patients who underwent PALND and those who only underwent CRT; and, fourth, the present study was performed by a multidisplinary team composed of gastrointestinal oncologists, oncologic surgeons, and radiologists, which made the management strategies more accurate.…”