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The Clinical Impact of Apical Lymph Node Metastasis of Colorectal Cancer After Curative Resection

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Abstract

Purpose

The present study aimed to investigate the clinical implications of apical lymph node metastasis (ALNM) after curative resection of stage III colorectal cancer.

Methods

A retrospective study was conducted of 1403 consecutive colorectal cancer patients who underwent surgical resection at a single institution between April 2008 and January 2020. The characteristics of ALNM, the recurrence status and the relapse-free survival (RFS) were examined.

Results

The numbers of patients with stage ≤ I, II, III, and IV disease were 350, 437, 476, and 140 patients, respectively. Among these patients with stage III disease, ALNM was seen in 21 patients (4.4% of stage III patients). Among them, curative resection was performed in 19 patients. Recurrence was observed in 68% (13/19) of the patients with ALNM who received curative resection. The first sites of recurrence included the lymph nodes 53.8% (7/13), liver 30.8% (4/13), lung 15.4% (2/13), brain 7.7% (1/13), bone 7.7% (1/13), and peritoneum 7.7% (1/13). There was no significant difference in the RFS of patients with ALNM who were managed with or without adjuvant chemotherapy (P = 0.207). Furthermore, the RFS of the group managed without adjuvant chemotherapy and the group that received adjuvant chemotherapy with/without oxaliplatin did not differ to a statistically significant extent (P = 0.318). In stage III colorectal cancer patients with ALNM, recurrence was observed significantly more frequently in comparison to stage III colorectal cancer patients without ALNM (P = 0.007). The first site of recurrence in patients with ALNM was most frequently seen in the distant lymph nodes (P = 0.004).

Conclusion

Our findings suggest that ALNM is strongly associated with recurrence in the distant lymph nodes and that it may lead to the development of systemic disease. The current regimen for stage III colorectal cancer may therefore not be sufficient for patients with stage III ALNM.

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Acknowledgements

The authors would like to thank Dr. Keiichiro Okuyama, Dr. Hiroshi Kubo, Dr. Osamu Ikeda, Dr. Atsushi Miyoshi, and Dr. Seiji Sato who all belong to Department of Surgery, Saga Medical Center Koseikan, Saga, Japan, for treating the patients and their useful discussions. We also thank Ms. Shiori Joujima who belongs to Medical Information Division, Life Science Research Institution, Saga Medical Center Koseikan, Saga, Japan, for the data collection.

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Authors and Affiliations

  1. Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 840-8571, Japan

    Masatsugu Hiraki, Toshiya Tanaka, Hirofumi Sato & Kenji Kitahara

  2. Life Science Research Institution, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 840-8571, Japan

    Masatsugu Hiraki & Eiji Sadashima

Authors
  1. Masatsugu Hiraki
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  2. Toshiya Tanaka
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  3. Eiji Sadashima
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  4. Hirofumi Sato
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  5. Kenji Kitahara
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Contributions

M Hiraki and T Tanaka designed this study. M Hiraki, T Tanaka, H Sato, and K Kitahara treated the patients. M Hiraki and E Sadashima (specialist in statistics) analyzed the data. M Hiraki and T Tanaka interpreted the results and wrote the manuscript.

Corresponding author

Correspondence to Masatsugu Hiraki.

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Ethics Approval

The medical ethics committee of Saga Medical Center Koseikan reviewed and approved this study design (permission number: 21–03-01–04).

Consent to Participate

All patients and their families were informed about the surgical procedure and provided their written consent. Informed broad consent for this study was obtained.

Conflict of Interest

The authors declare no competing interests.

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Hiraki, M., Tanaka, T., Sadashima, E. et al. The Clinical Impact of Apical Lymph Node Metastasis of Colorectal Cancer After Curative Resection. J Gastrointest Canc 54, 506–512 (2023). https://doi.org/10.1007/s12029-022-00828-w

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  • DOI: https://doi.org/10.1007/s12029-022-00828-w

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