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

Sakamoto, Junichi; Ozawa, Heita; Nakanishi, Hiroki; Fujita, Shin

doi:10.21203/rs.3.rs-24720/v1

Cited by 4 publications

(4 citation statements)

References 6 publications

(6 reference statements)

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“…The 5‐year OS was 33.9% and 3‐year OS 46.2%, reported by Bae et al and Sakamoto et al respectively. Three‐year DFS was 23.1% 14,19 . No recurrence data was available for the colonic cohort.…”

Section: Resultsmentioning

confidence: 99%

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Survival outcomes after synchronous para‐aortic lymph node metastasis in colorectal cancer: A systematic review

Aylward

Noori

Tyrrell

et al. 2022

Journal of Surgical Oncology

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Background: Synchronous para-aortic lymph node metastasis (PALNM) in colorectal cancer (CRC) is a relatively rare clinical entity. There is a lack of consensus on management of these patients, and the role of para-aortic lymph node dissection (PALND) remains controversial. This systematic review aims to describe the survival outcomes in colorectal cancer with synchronous PALNM when lymph node dissection is performed. Methods: A systematic review of Pubmed, Embase and Web of Science databases for PALND in CRC was performed. Studies including patients with synchronous PALNM undergoing resection with curative intent, published from the year 2000 onwards, were included.Results: Twelve retrospective studies were included. Four studies reported survival outcomes for rectal cancer, two for colon cancer and six as colorectal. Survival outcomes for 356 patients were included. Average 5-year overall survival (OS) was 22.4%, 33.9% and 37.7% in the rectal, colon and colorectal groups respectively. Three year OS in the groups was 53.6%, 46.2% and 65.7%. Conclusion:There remains a lack of quality data to confidently make recommendations regarding the management of synchronous PALNM in colon and rectal cancer cohorts. Retrospective data suggests a benefit in highly selective cohorts and therefore a case-by-case evaluation remains the standard of care.

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Section: Resultsmentioning

confidence: 99%

“…Only Sakamoto et al reported on 3-year DFS at 12.5%. 19 No specific recurrence data for rectal cancers were available.…”

Section: Rectal Cohortmentioning

confidence: 99%

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Survival outcomes after synchronous para‐aortic lymph node metastasis in colorectal cancer: A systematic review

Aylward

Noori

Tyrrell

et al. 2022

Journal of Surgical Oncology

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“…This study was limited by the single-centre experience, and the results need to be externally validated. Also, it lacks long-term follow-up to correlate the findings with patient prognosis, as previous studies in this field reported that resection of positive para-aortic lymph nodes had the potential to achieve R0 resection and longer survival 28 , 29 , thus results should be evaluated further in the light of patients’ long-term outcomes and possible recurrences.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine green for radical lymph node dissection in patients with sigmoid and rectal cancer: randomized clinical trial

et al. 2022

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Background D3 lymph node dissection is recommended for patients with advanced sigmoid and rectal cancer in Japan. This trial aimed to investigate the feasibility of indocyanine green (ICG) as a tracer to increase the nodal harvest during D3 lymph node dissection in patients with sigmoid and rectal cancer. Methods This prospective randomized clinical trial was performed between May 2021 and April 2022. The inclusion criteria were patients with stage I–III sigmoid or rectal cancer eligible for laparoscopic resection. Patients were 1: 1 randomized to either the ICG group (endoscopic ICG injection at the tumour site and intraoperative imaging to guide dissection) or the control group (routine laparoscopic white-light imaging). All patients were treated with D3 dissection, and the primary outcome was the number of harvested lymph nodes at the D3 level. Results Out of 210 patients screened, a total of 66 patients were enrolled and randomized. Patients in the two groups presented similar ages and clinical stages (ICG group versus control group, median age of 58.0 versus 58.5 years; stage III 36.4 per cent versus 36.4 per cent, whereas the rate of rectal cancer was 27.3 per cent versus 48.5 per cent respectively). ICG imaging was helpful for completely dissecting D3 lymph nodes and could identify a median of more than 2 (range 1–6) D3 lymph nodes neglected by routine laparoscopic white-light imaging during surgery. The median number of D3 lymph nodes harvested in the ICG group was significantly higher than that in the control group (7.0 versus 5.0, P = 0.003); however, there was no significant difference in the median numbers of positive D1, D2, and D3 lymph nodes between the two groups. Conclusion ICG is safe and feasible to guide D3 lymph node dissection and can increase the number of harvested D3 lymph nodes in patients with sigmoid and rectal cancer. Registration number: NCT04848311 (http://www.clinicaltrials.gov).

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

Zizzo

Dorma

Zanelli

et al. 2022

Cancers

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Background: Para-aortic lymph node (PALN) metastases represent patterns of initial recurrence in only 2–6% CRC patients, after an estimated 23–28 month time interval. An increasing trend towards curative surgery has been witnessed in patients presenting with controlled PALN recurrence. Nevertheless, lack of consensus has impaired an unambiguous statement for PALN recurrence resection. Methods: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines, which led us to gain deeper insight into the prognostic factors and long-term outcomes after resection for synchronous or metachronous pathologically confirmed CRC isolated para-aortic lymph node metastases (PALNM). Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results: The nine articles included covered a study period of 30 years (1988–2018), with a total of 161 patients. At presentation, most primary CRCs were located in the colon (74%) and 95.6%, 87.1% and 76.9% patients had T3–T4, N1–N2 and well/moderately differentiated CRC, respectively. We identified a 59.4–68% 3-year OS rate and 53.4–87.5% 5-year OS rate, with a 25–84 months median OS, 26.3–61% 3-year DFS rate and 0–60.5% 5-year DFS rate, with a 14–24 month median DFS. Overall, 62.1% re-recurrence rate ranged from 43.8% to 100%. Conclusions: Although PALNMs resection in CRC patients may be considered a feasible and beneficial option, no conclusions or recommendations can be made taking into account the current evidence. Therefore, further randomized, possibly multicenter trials are strongly recommended and mandatory if we want to have our results confirmed and patient selection criteria clearly identified.

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

Cited by 4 publications

References 6 publications

Survival outcomes after synchronous para‐aortic lymph node metastasis in colorectal cancer: A systematic review

Survival outcomes after synchronous para‐aortic lymph node metastasis in colorectal cancer: A systematic review

Indocyanine green for radical lymph node dissection in patients with sigmoid and rectal cancer: randomized clinical trial

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

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