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

Abstract

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.

Surgical Excision For Para-Aortic Lymph Node Metastases After Radical Colorectal Cancer Resection: Case Series of Six Patients

“…At our hospital, PLN dissection is reserved for patients whose preoperative assessments indicate a potential for cure, limiting surgery to removal of enlarged lymph nodes. Although all of our patients routinely underwent open surgery, the safety of laparoscopic excision of PLNs has been documented elsewhere [14]. In this series, the sole postoperative complication was a Clavien-Dindo grade I paralytic ileus, underscoring the safety of these interventions.…”

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].…”

Applicability of minimally invasive surgery for clinically T4 colorectal cancer

“…The “intention-to-treat” principle indicated the removal of all grossly suspicious or evident metastatic lesions with ablation, radiotherapy or surgical method. Several previous studies have revealed the oncological benefits of debulking surgery for isolated pulmonary/hepatic metastases or abdominal nodal recurrence 22 , 23 . Furthermore, Johnson et al reported that a curative-intent trimodality approach could provide favorable survival in selected metastatic CRC patients with isolated retroperitoneal or mesenteric nodal recurrence.…”