Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer

Sahara, Kota; Watanabe, Jun; Ishibe, Atsushi; Suwa, Yusuke; Suwa, Hirokazu; Ota, Mitsuyoshi; Kunisaki, Chikara; Endo, Itaru

doi:10.1007/s00384-019-03294-2

Cited by 31 publications

(43 citation statements)

References 19 publications

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“…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 reached 25-53%, approximately 80% of the patients experience recurrence [4,[12][13][14][15] and few studies have discussed the recurrence pattern [12] or treatment after recurrence. Furthermore, no de nitive perioperative chemotherapy has been established.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, three retrospective studies have shown updated prognostic factors for synchronous PALND, including R0 resection, histological type, number of PALN, other distant metastases, metastatic lateral pelvic lymph node, and preoperative CEA values [4,15,16]. However, the prognostic factors for synchronous PALND identi ed in the previous studies are not yet universal.…”

Section: Introductionmentioning

confidence: 99%

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The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Ushigome

Yasui

Ohue

et al. 2020

Preprint

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Ushigome

Yasui

Ohue

et al. 2020

Preprint

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“…In the present study, postoperative morbidity occurred in 31.0% of patients, which was comparable with that of other studies (7.8-38.9%). [10][11][12][13][14] The main morbidity was surgical site infection, and the rate of Clavien and Dindo classification grade Ⅲ or above was only 10.3%, with no perioperative death. These results suggest that the incidence of postoperative morbidities associated with PALN dissection is within acceptable limits.…”

Section: Discussionmentioning

confidence: 99%

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

Sakamoto

Ozawa

Nakanishi

et al. 2020

Preprint

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Background The optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer.Methods Between January 1986 and August 2016, 29 patients with pathologically positive PALN metastasis who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in patients with PALN metastasis.Results The 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. Six (20.7%) patients experienced no recurrence in the three years after surgery. Postoperative complications were seen in nine (31.0%) patients. The three-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032).Conclusions PALN dissection for left-sided colon or rectal cancer with synchronous PALN metastasis can be a feasible treatment option in selected patients.

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“…Our study was limited to patients who underwent R0 resection based on previous reports that R0 resection has a better prognosis than R1-2 resection [14,15]. The 5-year OS and RFS rates in 20 patients with synchronous metastatic PALN who underwent PALND were 38.2% and 25%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, three retrospective studies have shown updated prognostic factors for synchronous PALND, including R0 resection, histological type, number of PALN, other distant metastases, metastatic lateral pelvic lymph node, and preoperative CEA values [4,15,16]. However, the prognostic factors for synchronous PALND identified in the previous studies are not yet universal.…”

Section: Introductionmentioning

confidence: 99%

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

Ushigome

Yasui

Ohue

et al. 2020

Preprint

View full text Add to dashboard Cite

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 38% 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 = 0.016), time to recurrence (p = 0.006), and recurrence resection (p = 0.008) 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.

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Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer

Cited by 31 publications

References 19 publications

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

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

The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

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