The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis
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(2020) 18:229
RESEARCH
Open Access
The treatment strategy of R0 resection in colorectal cancer with synchronous paraaortic lymph node metastasis Hajime Ushigome1, Masayoshi Yasui1*, Masayuki Ohue1, Naoaki Haraguchi1, Junichi Nishimura1, Keijirou Sugimura1, Kazuyoshi Yamamoto1, Hiroshi Wada1, Hidenori Takahashi1, Takeshi Omori1, Hiroshi Miyata1 and Shuji Takiguchi2
Abstract 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. Keywords: Para-aortic lymph node metastasis, Synchronous, Colorectal cancer
Background 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]. In stage IV patients, R0 resection is usually recommended for resectable liver or lung metastases [2, 5–7]. However, metastatic PALN remains highly controversial as no multicenter studies or randomized controlled trials have
* Correspondence: [email protected] 1 Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan Full list of author information is available at the end of the article
been performed on synchronous or metachronous PALN dissection (PALND). A few studies have been published on metachronous metastatic PALN [8–11], and studies on synchronous metastatic PALN have shown that PALND below the renal veins can be performed safely, prolonging prognosis compared to non-surgical resection [12, 13]. 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 reache
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