Colorectal Cancer

  • Kazushige KawaiEmail author
  • Kensuke Otani
  • Manabu Kaneko
  • Koji Murono
  • Kazuhito Sasaki
  • Toshiaki Watanabe


The location of the lymph nodes and the extent of their removal for an optimal response have been much discussed in the history of surgery, and considerable research in this field is still being conducted today. If lesions are removed with too wide margins, unnecessary complications can occur with no additional survival benefit. In contrast, incomplete lymph node dissection might leave residual cancer cells, which could cause disease recurrence in lymph nodes or local sites. For this perspective, the significance of performing complete mesocolic excision for colon cancer and total mesorectal excision for rectal cancer has been focused in recent years. Central vascular ligation has also been considered to be important in the lymph node dissection for colorectal cancer.

In this chapter, we describe the latest trends in the treatment for lymph node metastasis from colorectal cancer under four headings: (1) metastasis to mesenteric lymph nodes, (2) metastasis to lateral pelvic lymph nodes from rectal cancer, (3) metastasis to other distant lymph nodes, and (4) lymph node metastasis from T1 cancer.


Complete mesocolic excision Total mesorectal excision Central vascular ligation Lateral lymph node dissection 


  1. 1.
    Cady B. Lymph node metastases. Indicators, but not governors of survival. Arch Surg. 1984;119:1067–72.CrossRefGoogle Scholar
  2. 2.
    Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99:433–41.CrossRefGoogle Scholar
  3. 3.
    Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd, Cummings B, Gunderson L, Macdonald JS, Mayer RJ. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol. 2001;19:157–63.CrossRefGoogle Scholar
  4. 4.
    Kanemitsu Y, Komori K, Ishiguro S, Watanabe T, Sugihara K. The relationship of lymph node evaluation and colorectal cancer survival after curative resection: a multi-institutional study. Ann Surg Oncol. 2012;19:2169–77.CrossRefGoogle Scholar
  5. 5.
    Kotake K, Honjo S, Sugihara K, Hashiguchi Y, Kato T, Kodaira S, Muto T, Koyama Y. Number of lymph nodes retrieved is an important determinant of survival of patients with stage II and stage III colorectal cancer. Jpn J Clin Oncol. 2012;42:29–35.CrossRefGoogle Scholar
  6. 6.
    Greenson JK, Isenhart CE, Rice R, Mojzisik C, Houchens D, Martin EW Jr. Identification of occult micrometastases in pericolic lymph nodes of Duke’s B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer. 1994;73:563–9.CrossRefGoogle Scholar
  7. 7.
    Jeffers MD, O’Dowd GM, Mulcahy H, Stagg M, O’Donoghue DP, Toner M. The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J Pathol. 1994;172:183–7.CrossRefGoogle Scholar
  8. 8.
    Rosenberg R, Hoos A, Mueller J, Baier P, Stricker D, Werner M, Nekarda H, Siewert JR. Prognostic significance of cytokeratin-20 reverse transcriptase polymerase chain reaction in lymph nodes of node-negative colorectal cancer patients. J Clin Oncol. 2002;20:1049–55.CrossRefGoogle Scholar
  9. 9.
    Peschaud F, Benoist S, Julie C, Beauchet A, Penna C, Rougier P, Nordlinger B. The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer. Ann Surg. 2008;248:1067–73.CrossRefGoogle Scholar
  10. 10.
    Ceelen W, Van Nieuwenhove Y, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol. 2010;17:2847–55.CrossRefGoogle Scholar
  11. 11.
    Lu YJ, Lin PC, Lin CC, Wang HS, Yang SH, Jiang JK, Lan YT, Lin TC, Liang WY, Chen WS, Lin JK, Chang SC. The impact of the lymph node ratio is greater than traditional lymph node status in stage III colorectal cancer patients. World J Surg. 2013;37:1927–33.CrossRefGoogle Scholar
  12. 12.
    Ozawa T, Ishihara S, Nishikawa T, Tanaka T, Tanaka J, Kiyomatsu T, Hata K, Kawai K, Nozawa H, Kanazawa T, Kazama S, Yamaguchi H, Sunami E, Kitayama J, Watanabe T. Prognostic significance of the lymph node ratio in stage IV colorectal cancer patients who have undergone curative resection. Ann Surg Oncol. 2015;22:1513–9.CrossRefGoogle Scholar
  13. 13.
    Zhang MR, Xie TH, Chi JL, Li Y, Yang L, Yu YY, Sun XF, Zhou ZG. Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis. Oncotarget. 2016;7:72898–907.PubMedPubMedCentralGoogle Scholar
  14. 14.
    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 364–355CrossRefGoogle Scholar
  15. 15.
    Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, Ohue M, Fujii S, Shiozawa M, Yamaguchi T, Moriya Y. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13:616–21.CrossRefGoogle Scholar
  16. 16.
    Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–39.CrossRefGoogle Scholar
  17. 17.
    West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9:857–65.CrossRefGoogle Scholar
  18. 18.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28:272–8.CrossRefGoogle Scholar
  19. 19.
    Paquette IM, Madoff RD, Sigurdson ER, Chang GJ. Impact of proximal vascular ligation on survival of patients with colon cancer. Ann Surg Oncol. 2018;25:38–45.CrossRefGoogle Scholar
  20. 20.
    Kotake K, Mizuguchi T, Moritani K, Wada O, Ozawa H, Oki I, Sugihara K. Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Color Dis. 2014;29:847–52.CrossRefGoogle Scholar
  21. 21.
    Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.CrossRefGoogle Scholar
  22. 22.
    Park IJ, Choi GS, Kang BM, Lim KH, Jun SH. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe? Ann Surg Oncol. 2009;16:1501–6.CrossRefGoogle Scholar
  23. 23.
    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.CrossRefGoogle Scholar
  24. 24.
    Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.CrossRefGoogle Scholar
  25. 25.
    Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg. 1995;82:1031–3.CrossRefGoogle Scholar
  26. 26.
    Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336:980–7.CrossRefGoogle Scholar
  27. 27.
    Kapiteijn E, Kranenbarg EK, Steup WH, Taat CW, Rutten HJ, Wiggers T, van Krieken JH, Hermans J, Leer JW, van de Velde CJ. Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Prospective randomised trial with standard operative and histopathological techniques. Dutch ColoRectal Cancer Group. Eur J Surg. 1999;165:410–20.CrossRefGoogle Scholar
  28. 28.
    Lowry AC, Simmang CL, Boulos P, Farmer KC, Finan PJ, Hyman N, Killingback M, Lubowski DZ, Moore R, Penfold C, Savoca P, Stitz R, Tjandra JJ. Consensus statement of definitions for anorectal physiology and rectal cancer: report of the Tripartite Consensus Conference on Definitions for Anorectal Physiology and Rectal Cancer, Washington, D.C., May 1, 1999. Dis Colon Rectum. 2001;44:915–9.CrossRefGoogle Scholar
  29. 29.
    Corder AP, Karanjia ND, Williams JD, Heald RJ. Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg. 1992;79:680–2.CrossRefGoogle Scholar
  30. 30.
    Rutegard M, Hemmingsson O, Matthiessen P, Rutegard J. High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg. 2012;99:127–32.CrossRefGoogle Scholar
  31. 31.
    Kobayashi M, Okamoto K, Namikawa T, Okabayashi T, Araki K. Laparoscopic lymph node dissection around the inferior mesenteric artery for cancer in the lower sigmoid colon and rectum: is D3 lymph node dissection with preservation of the left colic artery feasible? Surg Endosc. 2006;20:563–9.CrossRefGoogle Scholar
  32. 32.
    Fernandez-Acenero MJ, Granja M, Sastre J, Garcia-Paredes B, Estrada L. Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma. Virchows Arch. 2016;468:425–30.CrossRefGoogle Scholar
  33. 33.
    Okada K, Sadahiro S, Suzuki T, Tanaka A, Okamura H, Kamijo A. Effect of chemoradiotherapy (CRT) for rectal cancer on the lymph nodes (LNs): exploration of the number of retrieved LNs, number of metastatic LNs, and the size of LNs. J Clin Oncol. 2012;30:651.CrossRefGoogle Scholar
  34. 34.
    Hall MD, Schultheiss TE, Smith DD, Fakih MG, Kim J, Wong JY, Chen YJ. Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer. Ann Surg Oncol. 2015;22(Suppl 3):S580–7.CrossRefGoogle Scholar
  35. 35.
    Damin DC, Rosito MA, Contu PC, Tarta C, Ferreira PR, Kliemann LM, Schwartsmann G. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg. 2012;16:1573–80.CrossRefGoogle Scholar
  36. 36.
    Ishihara S, Fukushima Y, Akahane T, Horiuchi A, Shimada R, Nakamura K, Aoyagi Y, Hayama T, Yamada H, Nozawa K, Matsuda K, Hashiguchi Y, Watanabe T. Number of lymph nodes in rectal cancer is correlated with response to preoperative chemoradiotherapy but is not associated with patient survival. Hepato-Gastroenterology. 2014;61:1000–7.PubMedGoogle Scholar
  37. 37.
    Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, Gama-Rodrigues J. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10:1319–28. discussion 1328–1319CrossRefGoogle Scholar
  38. 38.
    Li J, Liu H, Yin J, Liu S, Hu J, Du F, Yuan J, Lv B, Fan J, Leng S, Zhang X. Wait-and-see or radical surgery for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy: a cohort study. Oncotarget. 2015;6:42354–61.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP, Proscurshim I, Sabbagh C, Lynn PB, Perez RO. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys. 2014;88:822–8.CrossRefGoogle Scholar
  40. 40.
    Sprenger T, Rothe H, Conradi LC, Beissbarth T, Kauffels A, Kitz J, Homayounfar K, Wolff H, Strobel P, Ghadimi M, Wittekind C, Sauer R, Rodel C, Liersch T. Stage-dependent frequency of lymph node metastases in patients with rectal carcinoma after preoperative chemoradiation: results from the CAO/ARO/AIO-94 trial and from a comparative prospective evaluation with extensive pathological workup. Dis Colon Rectum. 2016;59:377–85.CrossRefGoogle Scholar
  41. 41.
    Ogawa S, Hida J, Ike H, Kinugasa T, Ota M, Shinto E, Itabashi M, Okamoto T, Sugihara K. The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum. Int J Color Dis. 2016;31:1719–28.CrossRefGoogle Scholar
  42. 42.
    WE M. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3.Google Scholar
  43. 43.
    Grinnell RS. The lymphatic and venous spread of carcinoma of the rectum. Ann Surg. 1942;116:200–16.CrossRefGoogle Scholar
  44. 44.
    Senba Y. An anatomical study of the lymphatic system of the rectum. J Fukuoka Med Coll. 1927;20:1213–68.Google Scholar
  45. 45.
    Stearns MW Jr, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum. 1959;2:169–72.CrossRefGoogle Scholar
  46. 46.
    Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, Kameoka S, Saito Y, Takahashi K, Hase K, Oya M, Maeda K, Hirai T, Kameyama M, Shirouzu K, Muto T. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141:67–75.CrossRefGoogle Scholar
  47. 47.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.CrossRefGoogle Scholar
  48. 48.
    Hojo K. Extended wide lymphadenectomy and preservation of pelvic autonomic nerves in the rectal cancer surgery. G Chir. 1989;10:149–53.PubMedGoogle Scholar
  49. 49.
    Hojo K, Koyama Y. The effectiveness of wide anatomical resection and radical lymphadenectomy for patients with rectal cancer. Jpn J Surg. 1982;12:111–6.CrossRefGoogle Scholar
  50. 50.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefGoogle Scholar
  51. 51.
    Engstrom PF, Arnoletti JP, Benson AB 3rd, Chen YJ, Choti MA, Cooper HS, Covey A, Dilawari RA, Early DS, Enzinger PC, Fakih MG, Fleshman J Jr, Fuchs C, Grem JL, Kiel K, Knol JA, Leong LA, Lin E, Mulcahy MF, Rao S, Ryan DP, Saltz L, Shibata D, Skibber JM, Sofocleous C, Thomas J, Venook AP, Willett C, National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: rectal cancer. J Natl Compr Canc Netw. 2009;7:838–81.CrossRefGoogle Scholar
  52. 52.
    Glimelius B, Tiret E, Cervantes A, Arnold D, E.G.W. Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi81–8.CrossRefGoogle Scholar
  53. 53.
    Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.CrossRefGoogle Scholar
  54. 54.
    Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, Japanese Society for Cancer of the Colon and Rectum. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255:1129–34.CrossRefGoogle Scholar
  55. 55.
    Ishihara S, Kanemitsu Y, Murono K, Otani K, Yasuda K, Nishikawa T, Tanaka T, Tanaka J, Kiyomatsu T, Kawai K, Hata K, Nozawa H, Kazama S, Yamaguchi H, Sunami E, Sugihara K, Watanabe T. Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis. Int J Color Dis. 2016;31:1315–21.CrossRefGoogle Scholar
  56. 56.
    Rectum JSfCotCa, editor. Japanese classification of colorectal carcinoma. English ed. Tokyo: Kanehara; 2013.Google Scholar
  57. 57.
    Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum. 2001;44:1274–80.CrossRefGoogle Scholar
  58. 58.
    Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–17.CrossRefGoogle Scholar
  59. 59.
    Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. 2nd English ed. Tokyo: Kanehara & Co. Ltd; 2009.Google Scholar
  60. 60.
    Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer. TNM classification of malignant tumours. 7th ed. Chichester: Wiley-Blackwell; 2010.Google Scholar
  61. 61.
    Graham RA, Hohn DC. Management of inguinal lymph node metastases from adenocarcinoma of the rectum. Dis Colon Rectum. 1990;33:212–6.CrossRefGoogle Scholar
  62. 62.
    Bebenek M, Wojnar A. Infralevator lymphatic drainage of low-rectal cancers: preliminary results. Ann Surg Oncol. 2009;16:887–92.CrossRefGoogle Scholar
  63. 63.
    Labianca R, Nordlinger B, Beretta GD, Brouquet A, Cervantes A, E.G.W. Group. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v70–7.CrossRefGoogle Scholar
  64. 64.
    Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg. 1982;144:350–4.CrossRefGoogle Scholar
  65. 65.
    Gagnière J, Dupré A, Chabaud S, Peyrat P, Meeus P, Rivoire M. Retroperitoneal nodal metastases from colorectal cancer: curable metastases with radical retroperitoneal lymphadenectomy in selected patients. Eur J Surg Oncol. 2015;41:731–7.CrossRefGoogle Scholar
  66. 66.
    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.CrossRefGoogle Scholar
  67. 67.
    Leggeri A, Roseano M, Balani A, Turoldo A. Liumboaortic and iliac lymphadenectomy: what is the role today? Dis Colon Rectum. 1994;37:S54–61.CrossRefGoogle Scholar
  68. 68.
    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.CrossRefGoogle Scholar
  69. 69.
    Shibata D, Paty PB, Guillem JG, Wong WD, Cohen AM. Surgical management of isolated retroperitoneal recurrences of colorectal carcinoma. Dis Colon Rectum. 2002;45:795–801.CrossRefGoogle Scholar
  70. 70.
    Min BS, Kim NK, Sohn SK, Cho CH, Lee KY, Baik SH. Isolated paraaortic lymph-node recurrence after the curative resection of colorectal carcinoma. J Surg Oncol. 2008;97:136–40.CrossRefGoogle Scholar
  71. 71.
    Min BS, Kim JS, Kim NK, Lim JS, Lee KY, Cho CH, Sohn SK. Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis. Ann Surg Oncol. 2009;16:3271–8.CrossRefGoogle Scholar
  72. 72.
    Bae SU, Han YD, Cho MS, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Oncologic outcomes of colon cancer patients with extraregional lymph node metastasis: comparison of isolated paraaortic lymph node metastasis with resectable liver metastasis. Ann Surg Oncol. 2016;23:1562–8.CrossRefGoogle Scholar
  73. 73.
    Ogura A, Akiyoshi T, Takatsu Y, Nagata J, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M. The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis. Asian J Surg. 2017;40:254–61.CrossRefGoogle Scholar
  74. 74.
    Song SH, Park SY, Park JS, Kim HJ, Yang CS, Choi GS. Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes. Ann Surg Treat Res. 2016;90:29–35.CrossRefGoogle Scholar
  75. 75.
    Kim MS, Cho CK, Yang KM, Lee DH, Moon SM, Shin YJ. Stereotactic body radiotherapy for isolated paraaortic lymph node recurrence from colorectal cancer. World J Gastroenterol. 2009;15:6091–5.CrossRefGoogle Scholar
  76. 76.
    Yeo SG, Kim DY, Kim TH, Jung KH, Hong YS, Kim SY, Park JW, Choi HS, Oh JH. Curative chemoradiotherapy for isolated retroperitoneal lymph node recurrence of colorectal cancer. Radiother Oncol. 2010;97:307–11.CrossRefGoogle Scholar
  77. 77.
    Lee J, Chang JS, Shin SJ, Lim JS, Keum KC, Kim NK, Ahn JB, Kim TI, Koom WS. Incorporation of radiotherapy in the multidisciplinary treatment of isolated retroperitoneal lymph node recurrence from colorectal cancer. Ann Surg Oncol. 2015;22:1520–6.CrossRefGoogle Scholar
  78. 78.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefGoogle Scholar
  79. 79.
    Bardia A, Greeno E, Miller R, Alberts S, Dozois E, Haddock M, Limburg P. Is a solitary inguinal lymph node metastasis from adenocarcinoma of the rectum really a metastasis? Color Dis. 2010;12:312–5.CrossRefGoogle Scholar
  80. 80.
    Adachi T, Hinoi T, Egi H, Ohdan H. Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome. Int J Color Dis. 2013;28:1675–80.CrossRefGoogle Scholar
  81. 81.
    Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Agostini N, Miccini M. Rectal cancer and inguinal metastases: prognostic role and therapeutic indications. Dis Colon Rectum. 1999;42:1464–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Kazushige Kawai
    • 1
    Email author
  • Kensuke Otani
    • 1
  • Manabu Kaneko
    • 1
  • Koji Murono
    • 1
  • Kazuhito Sasaki
    • 1
  • Toshiaki Watanabe
    • 1
  1. 1.Department of Surgical OncologyThe University of TokyoTokyoJapan

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