Skip to main content

Advertisement

SpringerLink
Log in

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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Greene FL. The American Joint Committee on Cancer: updating the strategies in cancer staging. Bull Am Coll Surg. 2002;87:13–15.

    PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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 364–5

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea

    Sung Uk Bae

  2. Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Sung Uk Bae, Yoon Dae Han MD, Min Soo Cho MD, Hyuk Hur MD, Byung Soh Min PhD, Seung Hyuk Baik PhD, Kang Young Lee PhD & Nam Kyu Kim PhD

Authors
  1. Sung Uk Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoon Dae Han MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Min Soo Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyuk Hur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Byung Soh Min PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seung Hyuk Baik PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kang Young Lee PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nam Kyu Kim PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nam Kyu Kim PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bae, S.U., Han, Y.D., Cho, M.S. et al. 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 23, 1562–1568 (2016). https://doi.org/10.1245/s10434-015-5027-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-5027-9

Keywords

Search

Navigation