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International Journal of Colorectal Disease

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01-06-2019 | Metastasis | Original Article

Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer

Authors: Kota Sahara, Jun Watanabe, Atsushi Ishibe, Yusuke Suwa, Hirokazu Suwa, Mitsuyoshi Ota, Chikara Kunisaki, Itaru Endo

Published in: International Journal of Colorectal Disease | Issue 6/2019

Abstract

Background

Para-aortic lymph node (PALN) metastasis of colorectal cancer is rare, and the treatment strategy for PALN metastasis (PALNM) is not established in contrast to liver or lung metastases. We sought to evaluate the survival outcomes and prognostic factors among patients undergoing surgery combined with extended lymphadenectomy for PALNM from left-sided colorectal cancer.

Methods

From 1992 to 2012, 322 patients who underwent PALN dissection (PALND) synchronously with primary resection, among 1819 left-sided colorectal surgical cases, were retrospectively examined. We investigated the overall survival (OS) and prognostic factors for patients with PALNM.

Results

Of the 322 patients, 62 (19.3%) were histologically confirmed to have PALNM. The 5-year OS in patients with and without PALNM was 19.5% and 67.0% (p < 0.001), respectively. Among patients with PALNM, on the multivariable analysis, the positive resection margin (hazard ratio (HR) 3.61; 95% confidence interval (CI) 1.85–7.06), undifferentiated histological type ((por/muc/sig), HR 4.51; 95% CI, 2.22–9.19), ≥ 4 PALNMs (HR 3.34; 95% CI 1.53–7.31), and preoperative CEA ≥ 10 ng/mL (HR 2.1; 95% CI 1.11–4.27) were significant prognostic factors. Among R0 resected cases, the 5-year OS of the 17 cases with ≤ 3 PALNM and well/moderately differentiated adenocarcinoma was 54.2%, which was comparable to that of patients undergoing PALND and diagnosed with stage IIIC (49.6%).

Conclusion

Patients with PALNM of colorectal cancer had a poor prognosis. However, curative resection, ≤ 3 PALNM, and well/moderately differentiated histology type were associated with the long-term survival.

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Title: Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer
Authors: Kota Sahara
Jun Watanabe
Atsushi Ishibe
Yusuke Suwa
Hirokazu Suwa
Mitsuyoshi Ota
Chikara Kunisaki
Itaru Endo
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Colorectal Cancer
Colorectal Cancer
Published in: International Journal of Colorectal Disease / Issue 6/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03294-2

At a glance: The STEP trials

Springer Medicine

Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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