Isolated paraaortic lymph‐node recurrence after the curative resection of colorectal carcinoma

Min, Byung Soh; Kim, Nam Kyu; Sohn, Seung Kook; Cho, Chang Hwan; Lee, Kang Young; Baik, Seung Hyuk

doi:10.1002/jso.20926

Cited by 90 publications

(123 citation statements)

References 13 publications

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“…However, the treatment of isolated PALN recurrence from CRC is not well established. Recently, Min et al [12] categorized PALN recurrence as a retroperitoneal recurrence, which is a type of locoregional recurrence. Furthermore, several studies [13][14][15][16] have investigated the therapeutic efficacies of surgery for retroperitoneal, intraabdominal, and PALN recurrences, and several reported outstanding survival rates, which appear to have resulted from the selection of patients with a resectable mass at time of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for isolated paraaorticlymph node recurrence from colorectal cancer

Kim¹,

Cho²,

Yang³

et al. 2009

WJG

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AIM:To evaluate the efficacy and complications of stereotactic body radiotherapy in localized paraaortic lymph node recurrence from colorectal cancer. From 2003From to 2009 patients with paraaortic lymph node recurrence (1-3 lesions) from colorectal cancer were treated with stereotactic body radiotherapy. Total gross tumor volumes ranged from 4 to 40 mL. The doses were escalated from 36 Gy/patient to 51 Gy/patient and were delivered in 3 fractions. METHODS: RESULTS:One and 3 year overall survival rates were 100% and 71.4%, respectively, and median survival was 37 mo. Grade Ⅳ intestinal obstruction was reported in 1 of 7 patients. This patient received 48 Gy in 3 fractions with a maximum point dose to the intestine of 53 Gy and V45Gy = 3.6 mL. However, 6 patients received an intestinal maximum point dose of < 51 Gy and V45Gy of < 1 mL, and did not develop any severe complications. CONCLUSION:This pilot study suggests selected paraaortic lymph node recurrence (1-3 closed lesions) that failed to respond to chemotherapy can be potentially salvaged by stereotactic body radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for isolated paraaorticlymph node recurrence from colorectal cancer

Kim¹,

Cho²,

Yang³

et al. 2009

WJG

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“…It is also well known that patients with isolated PALN metastasis were found to be very rare in the range 1.0-1.3% [15,16] , and a majority of PALN metastasis accompanied other distant sites of metastasis, such as the liver, lung, extraabdominal LNs, or peritoneal dissemination. Therefore, systemic chemotherapy was generally indicated for patients with PALN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…However, surprisingly, there are no large reports to show the past cruel results of PALND. Moreover, the clinical significance of PALND in the current era of modern chemotherapy has not been fully discussed [14][15][16] . In this study, we evaluated retrospectively the clinical significance of PALND for advanced or metastatic colorectal cancer in the current era of modern chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

et al. 2015

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Background/Aims: Surgical resection is not generally indicated for para-aortic lymph node (PALN) metastasis from colorectal cancer. However, the clinical significance of PALN dissection (PALND) in the current era of modern chemotherapy has not been fully discussed. Methods: Between November 2006 and February 2013, 14 patients underwent PALND for colorectal cancer and were proven as having pathological PALN metastasis. The median follow-up was 33.2 months. Results: Primary location was the right-colon in 2 patients, and the left-colon or rectum in 12 patients. The timing of metastasis was metachronous in 5 patients and synchronous in 9 patients. Eleven patients (79%) received perioperative aggressive modern chemotherapy. Neoadjuvant chemotherapy with targeted drugs was introduced in 9 patients (64%) and 6 patients received adjuvant chemotherapy. Recurrence after PALND occurred in 12 patients (86%). The most common site was the lung in 6 patients (43%). The 1- and 3-year disease-free survivals were 39.3 and 7.9%, respectively. The 3-year overall survival were 41.2%. Conclusion: The recurrence rate after PALND for strictly selected patients was quite high even in the current era of modern chemotherapy. However, some patients achieved long-term survival or could be cured. Therefore, we should re-evaluate the efficacy of PALND in a larger prospective study.

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“…On the other hand, para-aortic lymph node recurrence after curative surgery for colorectal cancer is more rare condition. It was reported that isolated para-aortic lymph node recurrence was identified in 1.3% of the patients who underwent curative surgery for colorectal cancer, and the median survival time from para-aortic lymph node recurrence for the resected patients was 34 mo, whereas it was 12 mo for those who did not undergo resection [13] . Lymph node metastasis outside the mesenteric lesion may represent metastasis from metastasis.…”

Section: A Bmentioning

confidence: 99%

Successful resection of metachronous para-aortic, Virchow lymph node and liver metastatic recurrence of rectal cancer

Takeshita

Fukunaga

Kimura

et al. 2015

WJG

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A 66-year-old female presented with the main complaint of defecation trouble and abdominal distention. With diagnosis of rectal cancer, cSS, cN0, cH0, cP0, cM0 cStage Ⅱ, Hartmann's operation with D3 lymph node dissection was performed and a para-aortic lymph node and a disseminated node near the primary tumor were resected. Histological examination showed moderately differentiated adenocarcinoma, pSS, pN3, pH0, pP1, pM1 (para-aortic lymph node, dissemination) fStage Ⅳ. After the operation, the patient received chemotherapy with FOLFIRI regimen. After 12 cycles of FOLFIRI regimen, computed tomography (CT) detected an 11 mm of liver metastasis in the posteroinferior segment of right hepatic lobe. With diagnosis of liver metastatic recurrence, we performed partial hepatectomy. Histological examination revealed moderately differentiated adenocarcinoma as a metastatic rectal cancer with cut end microscopically positive. After the second operation, the patient received chemotherapy with TS1 alone for 2 years. Ten months after the break, CT detected a 20 mm of paraaortic lymph node metastasis and a 10 mm of lymph node metastasis at the hepato-duodenal ligament. With diagnosis of lymph node metastatic recurrences, we performed lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma as metastatic rectal cancer in paraaortic and hepato-duodenal ligament areas. After the third operation, we started chemotherapy with modified FOLFOX6 regimen. After 2 cycles of modified FOLFOX6 regimen, due to the onset of neutropenia and liver dysfunction, we switched to capecitabine alone and continued it for 6 mo and then stopped. Eleven months after the break, CT detected two swelling 12 mm of lymph nodes at the left supraclavicular region. With diagnosis of Virchow lymph node metastatic recurrence, we started chemotherapy with capecitabine plus bevacizumab regimen. Due to the onset of neutropenia and hand foot syndrome (Grade 3), we managed to continue capecitabine administration with extension of interval period and dose reduction. After 2 years and 2 mo from starting capecitabine plus bevacizumab regimen, Virchow lymph nodes had slowly grown up to 17 mm. Because no recurrence had been detected besides Virchow lymph nodes for this follow up period, considering the side effects and quality of life, surgical resection was selected. We performed left supraclavicular lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma as a metastatic rectal cancer. After the fourth operation, the patient selected follow up without chemotherapy. Now we follow up her without recurrence and keep her quality of life high. Core tip: A 66-year-old female who had para-aortic lymph node metastasis and peritoneal dissemination of rectal cancer underwent Hartmann's operation. Beginning from stage Ⅳ, liver metastasis, paraaortic and hepato-duodenal ligament lymph node and Virchow lymph node recurrence were detected during follow up period. According to the previous reports...

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Isolated paraaortic lymph‐node recurrence after the curative resection of colorectal carcinoma

Abstract: IPLR after curative surgery for colorectal carcinoma is rare. Although it is generally associated with poor prognosis, better survival might be achieved through curative resection in selected cases.

Cited by 90 publications

References 13 publications

Stereotactic body radiotherapy for isolated paraaorticlymph node recurrence from colorectal cancer

Stereotactic body radiotherapy for isolated paraaorticlymph node recurrence from colorectal cancer

Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy

Successful resection of metachronous para-aortic, Virchow lymph node and liver metastatic recurrence of rectal cancer

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