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

Abstract

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.

Surgical Roles in the Management of Metachronus Para-aortic Lymph Node Recurrence and Synchronous Para-aortic Lymph Node Metastasis in Colorectal Cancer Patients

“…Our findings are in line with those of previous studies. 1 8 9 Our study was similar to the one by Ushigome et al, 9 which was also restricted to patients who underwent R0 resection of the primary tumor.…”

“…Additionally, in patients who do not undergo PALND, metastasis to distant organs may result from unresected PALN metastasis. 9 In the present study, the stage of the primary tumor was the most important prognostic factor for patient survival, and it was similar in patients who did and did not undergo resection.…”

“…Additionally, in patients who do not undergo PALND, metastasis to distant organs may result from unresected PALN metastasis. 9…”

“…This finding is similar to those of previous reports. 7,[10][11][12] Ushigome et al 9 showed that PALND is associated with favorable survival, but it was also associated with early unresectable recurrences. This might be due to the fact that the CRC patients who developed unresectable recurrences and died within one year after PALND were primarily found to have no indication for the procedure.…”

“…Moreover, MPR resectiombelow the renal veins can be safely performed and improve prognosis in comparison to non-surgical resection. 7 Recent studies 9,10 have updated the prognostic predictive parameters for the successful surgical management of SPM, including R0 resection, histological type, number of PALNs, presence of metastatic lateral pelvic lymph node, distant metastases, and preoperative levels of carcinoembryonic antigen (CEA).…”