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Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Metastasis | Research

Effect of radical lymphadenectomy in colorectal cancer with para-aortic lymph node metastasis: a systematic review and meta-analysis

Authors: Pengyue Zhao, Xingpeng Yang, Yang Yan, Jiaqi Yang, Songyan Li, Xiaohui Du

Published in: BMC Surgery | Issue 1/2022

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Abstract

Background

Colorectal cancer (CRC) with para-aortic lymph node metastasis (PALNM) is an intractable clinical situation, and the role of radical lymphadenectomy in the treatment of CRC with PALNM is still controversial. The aim of the current system review and meta-analysis is to evaluate the clinical efficacy and safety of radical lymphadenectomy in CRC patients with PALAN.

Methods

We performed a systematic search of PubMed, Embase, Cochrane Library and other online databases up to 31 October 2021. The clinical data including overall survival and postoperative complications were screened and analyzed after data extraction. Odds ratios (ORs) were applied to analyze these dichotomous outcomes with a fixed effects model.

Results

A total of 7 available retrospective clinical studies involving 327 patients were finally included. CRC patients with PALNM who underwent radical lymphadenectomy showed significantly overall survival (OR: 6.80, 95% CI: 3.46–13.38, P < 0.01; I2 = 0%) when compared to those who did not receive radical lymphadenectomy. Moreover, in terms of postoperative complications (OR: 0.71, 95% CI: 0.35–1.44, P = 0.48; I2 = 0%), there was no statistical difference between radical lymphadenectomy treatment and control groups.

Conclusions

The radical lymphadenectomy treatment has showed the expected clinical efficacy in prolonging overall survival time of CRC patients with PALAN. Moreover, the preemptive radical lymphadenectomy could not cause additional postoperative complications.
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Literature
1.
go back to reference Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A, Bray FJ. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRef Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A, Bray FJ. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRef
2.
go back to reference Sung J, Lau J, Goh K, Leung W. Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol. 2005;6(11):871–6.CrossRef Sung J, Lau J, Goh K, Leung W. Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol. 2005;6(11):871–6.CrossRef
3.
go back to reference Vatandoust S, Price T, Karapetis CJ. Colorectal cancer: metastases to a single organ. World J Gastroenterol. 2015;21(41):11767–76.CrossRef Vatandoust S, Price T, Karapetis CJ. Colorectal cancer: metastases to a single organ. World J Gastroenterol. 2015;21(41):11767–76.CrossRef
4.
go back to reference Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases—a population-based study on incidence, management and survival. BMC Cancer. 2018;18(1):78.CrossRef Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases—a population-based study on incidence, management and survival. BMC Cancer. 2018;18(1):78.CrossRef
5.
go back to reference Amin M, Greene F, Edge S, Compton C, Gershenwald J, Brookland R, Meyer L, Gress D, Byrd D, Winchester DJ. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017; 67(2):93–99. Amin M, Greene F, Edge S, Compton C, Gershenwald J, Brookland R, Meyer L, Gress D, Byrd D, Winchester DJ. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017; 67(2):93–99.
6.
go back to reference Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. 2020; 25(1):1–42. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. 2020; 25(1):1–42.
7.
go back to reference Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. 2012; 17(1):1–29. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. 2012; 17(1):1–29.
8.
go back to reference Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Which patients with isolated para-aortic lymph node metastasis will truly benefit from extended lymph node dissection for colon cancer? Cancer Res Treat. 2018;50(3):712–9.CrossRef Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Which patients with isolated para-aortic lymph node metastasis will truly benefit from extended lymph node dissection for colon cancer? Cancer Res Treat. 2018;50(3):712–9.CrossRef
9.
go back to reference 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(5):1562–8.CrossRef 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(5):1562–8.CrossRef
10.
go back to reference Zhao PY, Hu SD, Li YX, Yao RQ, Ren C, He CZ, Li SY, Wang YF, Yao YM, Huang XH, et al. Clinical efficacy and safety of hyperthermic intraperitoneal chemotherapy in colorectal cancer patients at high risk of peritoneal carcinomatosis: a systematic review and meta-analysis. Front Surg. 2020;7: 590452.CrossRef Zhao PY, Hu SD, Li YX, Yao RQ, Ren C, He CZ, Li SY, Wang YF, Yao YM, Huang XH, et al. Clinical efficacy and safety of hyperthermic intraperitoneal chemotherapy in colorectal cancer patients at high risk of peritoneal carcinomatosis: a systematic review and meta-analysis. Front Surg. 2020;7: 590452.CrossRef
11.
go back to reference Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical research ed). 2016;355: i4919. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical research ed). 2016;355: i4919.
12.
go back to reference Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37(5):1148–57.CrossRef Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37(5):1148–57.CrossRef
13.
go back to reference 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(1):66–71.CrossRef 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(1):66–71.CrossRef
14.
go back to reference Wong JS, Tan GH, Teo MC. Management of para-aortic lymph node metastasis in colorectal patients: a systemic review. Surg Oncol. 2016;25(4):411–8.CrossRef Wong JS, Tan GH, Teo MC. Management of para-aortic lymph node metastasis in colorectal patients: a systemic review. Surg Oncol. 2016;25(4):411–8.CrossRef
15.
go back to reference 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(1):29–35.CrossRef 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(1):29–35.CrossRef
16.
go back to reference 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(6):731–7.CrossRef 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(6):731–7.CrossRef
17.
go back to reference Ushigome H, Yasui M, Ohue M, Haraguchi N, Nishimura J, Sugimura K, Yamamoto K, Wada H, Takahashi H, Omori T, et al. The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis. World J Surg Oncol. 2020;18(1):229.CrossRef Ushigome H, Yasui M, Ohue M, Haraguchi N, Nishimura J, Sugimura K, Yamamoto K, Wada H, Takahashi H, Omori T, et al. The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis. World J Surg Oncol. 2020;18(1):229.CrossRef
18.
go back to reference Sasaki K, Nozawa H, Kawai K, Hata K, Tanaka T, Nishikawa T, Shuno Y, Kaneko M, Murono K, Emoto S, et al. Management of isolated para-aortic lymph node recurrence of colorectal cancer. Surg Today. 2020;50(9):947–54.CrossRef Sasaki K, Nozawa H, Kawai K, Hata K, Tanaka T, Nishikawa T, Shuno Y, Kaneko M, Murono K, Emoto S, et al. Management of isolated para-aortic lymph node recurrence of colorectal cancer. Surg Today. 2020;50(9):947–54.CrossRef
19.
go back to reference Kim Y, Park I, Park J, Kim T, Ro J, Lim S, Yu C, Kim J. Management of isolated para-aortic lymph node recurrence after surgery for colorectal cancer. Ann Surg Treat Res. 2020;98(3):130–8.CrossRef Kim Y, Park I, Park J, Kim T, Ro J, Lim S, Yu C, Kim J. Management of isolated para-aortic lymph node recurrence after surgery for colorectal cancer. Ann Surg Treat Res. 2020;98(3):130–8.CrossRef
20.
go back to reference Lee J, Park HM, Lee SY, Kim CH, Kim HR. Prognostic significance of enlarged paraaortic lymph nodes detected during left-sided colorectal cancer surgery: a single-center retrospective cohort study. World J Surg Oncol. 2021;19(1):9.CrossRef Lee J, Park HM, Lee SY, Kim CH, Kim HR. Prognostic significance of enlarged paraaortic lymph nodes detected during left-sided colorectal cancer surgery: a single-center retrospective cohort study. World J Surg Oncol. 2021;19(1):9.CrossRef
21.
go back to reference Ichikawa Y, Takahashi H, Fujii M, Hata T, Ogino T, Miyoshi N, Uemura M, Yamamoto H, Mizushima T, Doki Y, et al. Radical lymphadenectomy of a para-aorta lymph node metastasis in colorectal cancer prolongs relapse-free survival. Int J Colorectal Dis. 2021;36(7):1551–60.CrossRef Ichikawa Y, Takahashi H, Fujii M, Hata T, Ogino T, Miyoshi N, Uemura M, Yamamoto H, Mizushima T, Doki Y, et al. Radical lymphadenectomy of a para-aorta lymph node metastasis in colorectal cancer prolongs relapse-free survival. Int J Colorectal Dis. 2021;36(7):1551–60.CrossRef
22.
go back to reference Lee SH, Lee JL, Kim CW, Lee HI, Yu CS, Kim JC. Oncologic significance of para-aortic lymph node and inferior mesenteric lymph node metastasis in sigmoid and rectal adenocarcinoma. Eur J Surg Oncol. 2017;43(11):2076–83.CrossRef Lee SH, Lee JL, Kim CW, Lee HI, Yu CS, Kim JC. Oncologic significance of para-aortic lymph node and inferior mesenteric lymph node metastasis in sigmoid and rectal adenocarcinoma. Eur J Surg Oncol. 2017;43(11):2076–83.CrossRef
23.
go back to reference Slesser A, Georgiou P, Brown G, Mudan S, Goldin R, Tekkis PJC. The tumour biology of synchronous and metachronous colorectal liver metastases: a systematic review. Clin Exp Metastasis. 2013;30(4):457–70.CrossRef Slesser A, Georgiou P, Brown G, Mudan S, Goldin R, Tekkis PJC. The tumour biology of synchronous and metachronous colorectal liver metastases: a systematic review. Clin Exp Metastasis. 2013;30(4):457–70.CrossRef
24.
go back to reference Lurvink R, Bakkers C, Rijken A, van Erning F, Nienhuijs S, Burger J, Creemers G, Verhoef C, Lemmens V, De Hingh I, et al. Increase in the incidence of synchronous and metachronous peritoneal metastases in patients with colorectal cancer: a nationwide study. Eur J Surg Oncol. 2021;47(5):1026–33.CrossRef Lurvink R, Bakkers C, Rijken A, van Erning F, Nienhuijs S, Burger J, Creemers G, Verhoef C, Lemmens V, De Hingh I, et al. Increase in the incidence of synchronous and metachronous peritoneal metastases in patients with colorectal cancer: a nationwide study. Eur J Surg Oncol. 2021;47(5):1026–33.CrossRef
25.
go back to reference Suthananthan A, Bhandari M, Platell C. Influence of primary site on metastatic distribution and survival in stage IV colorectal cancer. ANZ J Surg. 2018;88(5):445–9.CrossRef Suthananthan A, Bhandari M, Platell C. Influence of primary site on metastatic distribution and survival in stage IV colorectal cancer. ANZ J Surg. 2018;88(5):445–9.CrossRef
26.
go back to reference Hentzen J, Rovers K, Kuipers H, van der Plas W, Been L, Hoogwater F, van Ginkel R, Hemmer P, van Dam G, de Hingh I, et al. Impact of synchronous versus metachronous onset of colorectal peritoneal metastases on survival outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC): a multicenter retrospective, observational study. Ann Surg Oncol. 2019;26(7):2210–21.CrossRef Hentzen J, Rovers K, Kuipers H, van der Plas W, Been L, Hoogwater F, van Ginkel R, Hemmer P, van Dam G, de Hingh I, et al. Impact of synchronous versus metachronous onset of colorectal peritoneal metastases on survival outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC): a multicenter retrospective, observational study. Ann Surg Oncol. 2019;26(7):2210–21.CrossRef
27.
go back to reference Cavallaro P, Bordeianou L, Stafford C, Clark J, Berger D, Cusack J, Kunitake H, Francone T, Ricciardi R. Impact of single-organ metastasis to the liver or lung and genetic mutation status on prognosis in stage IV colorectal cancer. Clin Colorectal Cancer. 2020;19(1):e8–17.CrossRef Cavallaro P, Bordeianou L, Stafford C, Clark J, Berger D, Cusack J, Kunitake H, Francone T, Ricciardi R. Impact of single-organ metastasis to the liver or lung and genetic mutation status on prognosis in stage IV colorectal cancer. Clin Colorectal Cancer. 2020;19(1):e8–17.CrossRef
28.
go back to reference Wang Z, Wang X, Zhang Z, Wang X, Chen M, Lu L, Zhu W, Zhang J, Jia H, Chen J. Association between primary tumor location and prognostic survival in synchronous colorectal liver metastases after surgical treatment: a retrospective analysis of SEER Data. J Cancer. 2019;10(7):1593–600.CrossRef Wang Z, Wang X, Zhang Z, Wang X, Chen M, Lu L, Zhu W, Zhang J, Jia H, Chen J. Association between primary tumor location and prognostic survival in synchronous colorectal liver metastases after surgical treatment: a retrospective analysis of SEER Data. J Cancer. 2019;10(7):1593–600.CrossRef
Metadata
Title
Effect of radical lymphadenectomy in colorectal cancer with para-aortic lymph node metastasis: a systematic review and meta-analysis
Authors
Pengyue Zhao
Xingpeng Yang
Yang Yan
Jiaqi Yang
Songyan Li
Xiaohui Du
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01631-x

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