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Prognostic factors of para-aortic lymph node metastasis from colorectal cancer in highly selected patients undergoing para-aortic lymph node dissection

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Abstract

Purpose

We investigated the surgical outcomes of para-aortic lymph node (PALN) dissection in patients with colorectal cancer and assessed the prognostic factors related to the survival.

Methods

This single-center retrospective study included 31 patients with synchronous or metachronous PALN metastasis from colorectal cancer who underwent PALN dissection between January 2006 and December 2018.

Results

Twenty-one patients had synchronous PALN metastasis, and 10 had metachronous PALN metastasis. Seven patients had either simultaneous distant metastasis or a history of distant metastasis other than PALN metastasis at the time of PALN dissection. Eighteen patients underwent adjuvant chemotherapy. The 5-year overall and recurrence-free survival rates were 54.2 and 17.2%, respectively. A multivariable analysis revealed that rectal cancer, metachronous PALN metastasis, and three or more pathological PALN metastases were significantly poor prognostic factors for the recurrence-free survival. Among patients with rectal cancer, lower rectal cancer and lateral pelvic lymph node metastasis were poor prognostic factors for the overall survival.

Conclusion

Curative PALN dissection for PALN metastasis from colorectal cancer is feasible with favorable long-term outcomes. A multidisciplinary approach, including surgery and chemotherapy, is needed for colorectal cancer with PALN metastasis to improve the long-term outcomes.

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Data availability statement

The data are not available for public access because of patient privacy concerns but are available from the corresponding author upon reasonable request.

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Acknowledgments

We would like to thank Editage (www.editage.com) for providing the writing support. This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Shin Emoto, Yosuke Fukunaga, Shuhei Sano, Tetsuro Tominaga, Toshiki Mukai, Tomohiro Yamaguchi, Toshiya Nagasaki, Takashi Akiyoshi & Satoshi Nagayama

  2. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Manabu Takamatsu & Hiroshi Kawachi

  3. Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan

    Manabu Takamatsu & Hiroshi Kawachi

  4. Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tsuyoshi Konishi

  5. Department of Colorectal Surgery, Toranomon Hospital, Tokyo, Japan

    Masashi Ueno

Authors
  1. Shin Emoto
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  2. Yosuke Fukunaga
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  5. Shuhei Sano
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  8. Tomohiro Yamaguchi
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Contributions

Shin Emoto contributed to conceptualization, formal analysis, investigation, and writing—original draft. Yosuke Fukunaga contributed to conceptualization, formal analysis, and writing—review and editing. Manabu Takamatsu, Hiroshi Kawachi, Shuhei Sano, and Tetsuro Tominaga performed investigation and writing—review and editing. Toshiki Mukai, Takashi Akiyoshi, and Masashi Ueno performed investigation, supervision, and writing—review and editing. Tomohiro Yamaguchi performed formal analysis, supervision, and writing—review and editing. Toshiya Nagasaki, Tsuyoshi Konishi, and Satoshi Nagayama performed supervision and writing—review and editing. All authors agreed to the submission of the manuscript to the journal.

Corresponding author

Correspondence to Yosuke Fukunaga.

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Conflict of interest

The authors declare no conflict of interests.

Ethics statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study design was approved by the Ethical Committee of the Cancer Institute Hospital, Japanese Foundation for Cancer Research (Approval Number: 2018-1109). The need for informed consent was waived owing to the retrospective study design.

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Supplementary Information

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Supplementary file1 (DOCX 24 KB)

595_2023_2739_MOESM2_ESM.tif

Supplementary Fig. 1. Flowchart of patient selection for cases of para-aortic lymph node metastasis from colorectal cancer. Supplementary file2 (TIF 75 KB)

595_2023_2739_MOESM3_ESM.tif

Supplementary Fig. 2. Radiological features of para-aortic lymph node metastasis on computed tomography. Para-aortic lymph nodes (PALNs) were considered metastatic when the long-axis diameter was ≥ 10 mm and they had an irregular outer border and round shape with heterogeneous internal density on computed tomography (CT), or if they were 18F-fluorodeoxyglucose-avid on positron emission tomography (PET)-CT. (a) Enlarged PALN on CT in a patient with synchronous PALN metastasis. The long-axis diameter of the PALN on CT was 16 mm, and it had an irregular outer border and a heterogeneous internal density. (b) 18F-fluorodeoxyglucose-avid PALN on PET/CT. The maximum standard uptake value of this PALN was 16.7 on PET-CT: (a) and (b) were the same slice on CT. Supplementary file3 (TIF 176 KB)

595_2023_2739_MOESM4_ESM.tif

Supplementary Fig. 3. The overall survival (OS) and recurrence-free survival (RFS) of patients with pathologically positive para-aortic lymph node metastasis from colorectal cancer undergoing curative para-aortic lymph node dissection. The 5-year OS was 55.2%, and the 5-year RFS was 17.2% (median time of recurrence: 10 months). Supplementary file4 (TIF 47 KB)

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Emoto, S., Fukunaga, Y., Takamatsu, M. et al. Prognostic factors of para-aortic lymph node metastasis from colorectal cancer in highly selected patients undergoing para-aortic lymph node dissection. Surg Today 54, 356–366 (2024). https://doi.org/10.1007/s00595-023-02739-0

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