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

Abstract

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.

Standardize the surgical technique and clarify the oncologic significance of robotic D3-D4 lymphadenectomy for upper rectum and sigmoid colon cancer with clinically more than N2 lymph node metastasis

“…In general, surgeons are better trained in handling fresh specimens than pathologists and, thus, are more capable of meticulously retrieving lymph nodes from unfixed surgical specimens. Although this was not common practice for Western surgeons, we demonstrated that it achieved a satisfactory number of retrieved lymph nodes, up to a mean number of 34.4 per patient, which was higher than that reported previously 1 , 9 , 11 , 12 , 20 , 28 , 32 . Therefore, we believe that the large number of lymph nodes evaluated, and the methodology used to assess their anatomical location ensured the quality of lymph node mapping and subsequent survival correlation.…”

“…However, excessive lymph node dissection can result in additional surgical complications, including profuse bleeding, prolonged ileus, intra-abdominal abscess formation, wound infection, anastomotic leakage, and permanent loss of sexual function. Given the lack of quality data to weigh the survival benefits against surgical morbidities, most researchers have suggested that D3-D4 lymph node dissection should be implemented with already established treatment regimens within a multidisciplinary approach for patients with advanced colorectal cancer 11 , 12 . Further prospective multicenter international studies with standardized definitions and surgical techniques are required to better evaluate the long-term oncological outcomes of D3-D4 lymph node dissection.…”