The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis

Ogura, Atsushi; Akiyoshi, Takashi; Takatsu, Yukiko; Nagata, Jun; Nagasaki, Toshiya; Konishi, Tsuyoshi; Fujimoto, Yoshiya; Nagayama, Satoshi; Fukunaga, Yosuke; Ueno, Masashi

doi:10.1016/j.asjsur.2015.10.003

Cited by 33 publications

(65 citation statements)

References 15 publications

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“…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].…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

Zizzo

Dorma

Zanelli

et al. 2022

Cancers

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Background: Para-aortic lymph node (PALN) metastases represent patterns of initial recurrence in only 2–6% CRC patients, after an estimated 23–28 month time interval. An increasing trend towards curative surgery has been witnessed in patients presenting with controlled PALN recurrence. Nevertheless, lack of consensus has impaired an unambiguous statement for PALN recurrence resection. Methods: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines, which led us to gain deeper insight into the prognostic factors and long-term outcomes after resection for synchronous or metachronous pathologically confirmed CRC isolated para-aortic lymph node metastases (PALNM). Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results: The nine articles included covered a study period of 30 years (1988–2018), with a total of 161 patients. At presentation, most primary CRCs were located in the colon (74%) and 95.6%, 87.1% and 76.9% patients had T3–T4, N1–N2 and well/moderately differentiated CRC, respectively. We identified a 59.4–68% 3-year OS rate and 53.4–87.5% 5-year OS rate, with a 25–84 months median OS, 26.3–61% 3-year DFS rate and 0–60.5% 5-year DFS rate, with a 14–24 month median DFS. Overall, 62.1% re-recurrence rate ranged from 43.8% to 100%. Conclusions: Although PALNMs resection in CRC patients may be considered a feasible and beneficial option, no conclusions or recommendations can be made taking into account the current evidence. Therefore, further randomized, possibly multicenter trials are strongly recommended and mandatory if we want to have our results confirmed and patient selection criteria clearly identified.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

Zizzo

Dorma

Zanelli

et al. 2022

Cancers

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“…For example, Choi et al reported that the 5-year OS of the PALND group was significantly higher than that of the control group (53.4% vs. 12%, p = 0.045) [6]. Ogura et al reported that the 5-year cancer-specific survival was significantly higher in the R0 resection group than in the control group with palliative resection in patients with extra-regional lymph node metastasis [16]. Gagniere et al reported the outcome of radical retroperitoneal lymphadenectomy in patients with retroperitoneal nodal metastases from colorectal cancer [17].…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of enlarged paraaortic lymph nodes detected during left-sided colorectal cancer surgery: a single-center retrospective cohort study

et al. 2021

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Background Very few studies have been conducted on the treatment strategy for enlarged paraaortic lymph nodes (PALNs) incidentally detected during surgery. The purpose of this study was to investigate the benefit of lymph node dissection in patients with incidentally detected enlarged PALNs. Methods We retrospectively reviewed patients with left colon and rectal cancer who underwent surgical resection with PALN dissection between January 2010 and December 2018. The predictive factors for pathologic PALN metastasis (PALNM) were analyzed, and survival analyses were conducted to identify prognostic factors. Results Among 263 patients included, 19 (7.2%) showed pathologic PALNM and 5 (26.33%) had enlarged PALNs incidentally detected during surgery. These 5 patients accounted for 2.2% of 227 patients who had no evidence of PALNM on preoperative radiologic examination. Radiologic PALNM (odds ratio [OR] 12.737, 95% confidence interval [CI] 3.472–46.723) and radiologic distant metastasis other than PALNM (OR = 4.090, 95% CI 1.011–16.539) were independent predictive factors for pathologic PALNM. Pathologic T4 stage (hazard ratio [HR] 2.196, 95% CI 1.063–4.538) and R2 resection (HR 4.643, 95% CI 2.046–10.534) were independent prognostic factors for overall survival (OS). In patients undergoing R0 resection, pathologic PALNM was not associated with 5-year OS (90% vs. 82.2%, p = 0.896). Conclusion Dissection of enlarged PALNs incidentally detected during colorectal surgery may benefit patients with favorable survival outcomes.

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“…In addition, the average survival duration ( N = 6) for patients who undergo surgical resection after isolated PALN recurrence is 34 months, while that for patients who do not is 14 months [19]. In terms of comparative studies between experimental and control groups, one previous study was designed in a similar manner to ours but with a smaller number of patients [12]. Previous studies also demonstrated the effectiveness of para‐aortic lymphadenectomy but only in DG patients; no comparisons were made to NDG patients [9].…”

Section: Discussionmentioning

confidence: 99%

Effect of lymphadenectomy in colorectal cancer with isolated synchronous para‐aortic lymph node metastasis

et al. 2021

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Aim There is controversy about the treatment of para‐aortic lymph node (PALN) metastasis and usefulness of surgical removal. We investigated the clinical effects of synchronous isolated PALN dissection in patients with this metastasis. Methods Patients with colorectal cancer with isolated PALN metastasis were selected between January 2008 and December 2016 at Samsung Medical Center. Patients who were selected for gross‐free PALN dissection were set as the dissection group (DG). Patients who did not undergo PALN dissection or underwent biopsy were set as the non‐dissection group (NDG). The oncological and operative outcomes were compared. Results A total of 73 patients were recruited. The most clinical and pathological characteristics were not significantly different. The incidence of postoperative complications was also similar. The 5‐year overall survival of DG patients was 33.9%, that of NDG patients was 10.1%, and the survival curves were significantly different (P = 0.044). Multivariate analysis revealed that location of tumour in the left colon rather than in the right colon was a risk factor affecting survival in sub‐analysis. Conclusion PALN dissection did not increase postoperative complications and had a better effect on patient survival. It is suggested that lymphadenectomy be performed more aggressively when PALN metastasis is seen in patients with right colon cancer.

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The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis

Abstract: Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

Cited by 33 publications

References 15 publications

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

Prognostic significance of enlarged paraaortic lymph nodes detected during left-sided colorectal cancer surgery: a single-center retrospective cohort study

Effect of lymphadenectomy in colorectal cancer with isolated synchronous para‐aortic lymph node metastasis

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