Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1562–1568 | Cite as

Oncologic Outcomes of Colon Cancer Patients with Extraregional Lymph Node Metastasis: Comparison of Isolated Paraaortic Lymph Node Metastasis with Resectable Liver Metastasis

  • Sung Uk Bae
  • Yoon Dae Han
  • Min Soo Cho
  • Hyuk Hur
  • Byung Soh Min
  • Seung Hyuk Baik
  • Kang Young Lee
  • Nam Kyu KimEmail author
Colorectal Cancer

Abstract

Background

The treatment strategy and benefit of extended lymph node dissection among patients with preoperatively diagnosed paraaortic lymph node metastasis (PALNM) in colon cancer remains highly controversial. In the current study, we analyzed the oncologic outcomes of patients who underwent extraregional lymph node dissection for colon cancer with isolated PALNM.

Methods

From March 2000 to December 2009, the study group included 1082 patients who underwent curative surgery for colonic adenocarcinoma with pathological lymph node metastasis.

Results

Of 1082 patients who underwent curative surgery for colonic carcinoma, 953 (88.1 %) patients underwent regional lymphadenectomy, and 129 (11.9 %) patients underwent paraaortic lymph node dissection. Pathologic examination revealed N1 stage disease in 738 (68.2 %), N2 in 295 (27.3 %), and PALNM in 49 (4.5 %). Five-year overall survival (OS) and disease-free survival (DFS) rate were significantly better in the regional LNM group than in the PALNM group (OS 75.1 vs. 33.9 %, p < 0.001; DFS 66.2 vs. 26.5 %, p < 0.001). Five-year OS and DFS were not significantly different between the PALNM and resectable liver metastasis patients who underwent curative resection (OS 33.9 vs. 38.7 %, p = 0.080; DFS 26.5 vs. 27.6 %, p = 0.604).

Conclusions

PALNM in colon cancer is associated with poorer survival than regional lymph node metastasis and showed comparable survival rates with metastasectomy for liver metastasis. Further studies evaluating the net benefit of upfront chemotherapy compared with initial resection for patients with potentially resectable PALNM are needed.

Keywords

Overall Survival Oncologic Outcome Left Renal Vein Primary Tumor Resection Lateral Pelvic Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).

Disclosure

The authors have nothing to disclose.

References

  1. 1.
    Greene FL. The American Joint Committee on Cancer: updating the strategies in cancer staging. Bull Am Coll Surg. 2002;87:13–15.PubMedGoogle Scholar
  2. 2.
    Leggeri A, Roseano M, Balani A, Turoldo A. Lumboaortic and iliac lymphadenectomy: what is the role today? Dis Colon Rectum. 1994;37:S54–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Choi PW, Kim HC, Kim AY, Jung SH, Yu CS, Kim JC. Extensive lymphadenectomy in colorectal cancer with isolated para-aortic lymph node metastasis below the level of renal vessels. J Surg Oncol. 2010;101:66–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis. 2009;11:354–64; discussion 364–5CrossRefPubMedGoogle Scholar
  5. 5.
    Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N. Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg. 2015;261(4):708–15.CrossRefPubMedGoogle Scholar
  6. 6.
    Bae SU, Saklani AP, Lim DR, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol. 2014;21:2288–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Tokunaga M, Ohyama S, Hiki N, Fukunaga T, Aikou S, Yamaguchi T. Can superextended lymph node dissection be justified for gastric cancer with pathologically positive para-aortic lymph nodes? Ann Surg Oncol. 2010;17:2031–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Yoshikawa T, Sasako M, Sano T, et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial. Br J Surg. 2006;93:1526–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Min BS, Kim JS, Kim NK, et al. Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis. Ann Surg Oncol. 2009;16:3271–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Liu YL, Wang YH, Yang YM, Li MQ, Jiang SX, Wang XS. The role of para-aortic lymphadenectomy in surgical management of patients with stage N+ rectal cancer below the peritoneal reflection. Cell Biochem Biophys. 2012;62:41–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Glass RE, Ritchie JK, Thompson HR, Mann CV. The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy. Br J Surg. 1985;72:599–601.CrossRefPubMedGoogle Scholar
  13. 13.
    Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000;231:487–99.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248:829–35.PubMedGoogle Scholar
  15. 15.
    Covey AM, Brown KT, Jarnagin WR, et al. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg. 2008;247:451–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Blazer DG, 3rd, Kishi Y, Maru DM, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26:5344–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fernandez FG, Ritter J, Goodwin JW, Linehan DC, Hawkins WG, Strasberg SM. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg. 2005;200:845–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol. 2004;15:460–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Sung Uk Bae
    • 1
    • 2
  • Yoon Dae Han
    • 2
  • Min Soo Cho
    • 2
  • Hyuk Hur
    • 2
  • Byung Soh Min
    • 2
  • Seung Hyuk Baik
    • 2
  • Kang Young Lee
    • 2
  • Nam Kyu Kim
    • 2
    Email author
  1. 1.Division of Colorectal Surgery, Department of Surgery, School of MedicineKeimyung University and Dongsan Medical CenterDaeguKorea
  2. 2.Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance HospitalYonsei University College of MedicineSeoulKorea

Personalised recommendations