Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 9/2020

01-09-2020 | Metastasis | Review Article

Management of isolated para-aortic lymph node recurrence of colorectal cancer

Authors: Kazuhito Sasaki, Hiroaki Nozawa, Kazushige Kawai, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Yasutaka Shuno, Manabu Kaneko, Koji Murono, Shigenobu Emoto, Hirofumi Sonoda, Soichiro Ishihara

Published in: Surgery Today | Issue 9/2020

Login to get access

Abstract

Isolated para-aortic lymph node recurrence (PALNR) after curative surgery for colorectal cancer (CRC) is rare and its optimal management is not defined clearly. This review investigates the best outcomes among published studies on the management of PALNR in the field of CRC. We searched the PubMed database for studies reporting on the management of isolated PALNR in CRC, published in English or Japanese from January, 2000 to December, 2018. Studies including patients with other metastases were excluded. A total of 24 retrospective studies including 227 patients with PALNR were evaluated. The 3-year overall survival (OS) ranged from 60 to 100%, with a median OS of 34–80 months for patients who underwent PALNR dissection, and 14–42 months for patients who received non-surgical treatment. No surgery-related mortality was reported and the incidence of surgical, mainly low-grade, complications ranged from 33 to 52%. The predictors of improved survival outcome included R0 resection margins. Dissection for PALNR from CRC is considered a feasible treatment option that may yield a better prognosis than non-surgical treatment alone. Preoperative chemotherapy or CRT should be considered for their potential benefits, including a reduction in cancer volume and improved R0 resection rates.
Literature
1.
Figueredo A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R, et al. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer. 2003;3:26.CrossRef
2.
Kato T, Yasui K, Hirai T, Kanemitsu Y, Mori T, Sugihara K, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum. 2003;46(Suppl):S22–31.
3.
Watanabe K, Nagai K, Kobayashi A, Sugito M, Saito N. Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer. Br J Surg. 2009;96:1058–65.CrossRef
4.
Yamada Y, Takahari D, Matsumoto H, Baba H, Nakamura M, Yoshida K, et al. Leucovorin, fluorouracil, and oxaliplatin plus bevacizumab versus S-1 and oxaliplatin plus bevacizumab in patients with metastatic colorectal cancer (SOFT): an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol. 2013;14:1278–86.CrossRef
5.
Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15.CrossRef
6.
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.CrossRef
7.
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.CrossRef
8.
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.CrossRef
9.
Bowne WB, Lee B, Wong WD, Ben-Porat L, Shia J, Cohen AM, et al. Operative salvage for locoregional recurrent colon cancer after curative resection: an analysis of 100 cases. Dis Colon Rectum. 2005;48:897–909.CrossRef
10.
Yamamoto Y, Aoki M, Nakao K, Shitara K, Hayashi T, Fukunari H, et al. Four cases of colorectal cancer with para-aortic lymph node metastases successfully resected resulting in long-term survival. Gan Kagaku Ryoho Cancer Chemotherapy. 2016;43:1718–20.PubMed
11.
Takeshima K, Yamafuji K, Asami A, Baba H, Okamoto N, Takahashi H, et al. Successful resection of isolated para-aortic lymph node recurrence from advanced sigmoid colon cancer following 156 courses of FOLFIRI regimen. Case Rep Surg. 2016;2016:4548798.PubMedPubMedCentral
12.
Nishizawa Y, Hata T, Takahashi H, Haraguchi N, Nishimura J, Matsuda C, et al. A case of resection of para-aortic lymph node recurrence three years after curative surgery for ascending colon cancer. Gan Kagaku Ryoho Cancer Chemotherapy. 2016;43:2323–5.PubMed
13.
Ganno H, Kawaguchi M, Umebayashi Y, Aoyama S, Sugita H, Noguchi T, et al. Resection of paraaortic lymph node recurrence wherein complete response to bevacizumab was observed after surgery for sigmoid colon cancer. Gan Kagaku Ryoho Cancer Chemotherapy. 2016;43:1730–2.PubMed
14.
Sawami H, Murata M, Takahashi H, Tanaka N, Asai K, Saso K, et al. A case of recurrence of rectal cancer with para-aortic lymph node metastases successfully resected resulting in long term survival. Gan Kagaku Ryoho Cancer Chemotherapy. 2015;42:2310–2.PubMed
15.
Arimoto A, Uehara K, Kato T, Nakamura H, Kamiya T, Nagino M. Clinical significance of para-aortic lymph node dissection for advanced or metastatic colorectal cancer in the current era of modern chemotherapy. Dig Surg. 2015;32:439–44.CrossRef
16.
Yoshino J, Fukunari H, Kato T, Nakajima Y, Okajima C, Shitara K, et al. Curative dissection of paraaortic lymph node metastases after operation for ascending colon cancer. Gan Kagaku Ryoho Cancer Chemotherapy. 2014;41:1611–3.PubMed
17.
Razik R, Zih FS, Haase E, Mathieson A, Sandhu L, Cummings B, et al. Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer. Eur J Surg Oncol. 2014;40:739–46.CrossRef
18.
Sueda T, Noura S, Ohue M, Shingai T, Imada S, Gotoh K, et al. A case of rectal cancer with long-term disease-free survival following resection of the right iliac artery due to isolated para-aortic lymph node recurrence. Gan Kagaku Ryoho Cancer Chemotherapy. 2012;39:2258–60.PubMed
19.
Ishii M, Chiba N, Ono D, Nakamura T, Ishikawa S, Arisawa Y, et al. Lymph node metastasis from colon carcinoma at 11 years after the initial operation managed by lymph node resection and chemoradiation: a case report and a review of the literature. Int J Surg Case Rep. 2012;3:358–61.CrossRef
20.
Dumont F, Kothodinis K, Goere D, Honore C, Dartigues P, Boige V, et al. Central retroperitoneal recurrences from colorectal cancer: are lymph node and locoregional recurrences the same disease? Eur J Surg Oncol. 2012;38:611–6.CrossRef
21.
Fukunaga H, Ota H, Fujie Y, Shimizu K, Ogino T, Toyoda Y, et al. A case of surgical approach to the recurrence of the para-aortic lymph nodes after resection of rectal cancer. Gan Kagaku Ryoho Cancer Chemotherapy. 2009;36:2204–6.PubMed
22.
Sadahiro S, Suzuki T, Ishikawa K, Maeda Y, Saguchi T, Yasuda S, et al. Two patients with recurrent colon cancer who underwent surgery following a combination of irinotecan and UFT. Gan Kagaku Ryoho Cancer Chemotherapy. 2002;29:2013–8.PubMed
23.
Nishimura G, Funaki H, Michiwa Y, Nishigima K, Kitagawa H, Fushida S, et al. A case of a combined aortectomy with dissection of recurrent paraaortic lymph nodes of sigmoid colon cancer. Gan Kagaku Ryoho Cancer Chemotherapy. 2000;27:2001–4.PubMed
24.
Isozaki Y, Yamada S, Kawashiro S, Yasuda S, Okada N, Ebner D, et al. Carbon-ion radiotherapy for isolated para-aortic lymph node recurrence from colorectal cancer. J Surg Oncol. 2017;116:932–8.CrossRef
25.
Lee J, Chang JS, Shin SJ, Lim JS, Keum KC, Kim NK, et al. Incorporation of radiotherapy in the multidisciplinary treatment of isolated retroperitoneal lymph node recurrence from colorectal cancer. Ann Surg Oncol. 2015;22:1520–6.CrossRef
26.
Yeo SG, Kim DY, Kim TH, Jung KH, Hong YS, Kim SY, et al. Curative chemoradiotherapy for isolated retroperitoneal lymph node recurrence of colorectal cancer. Radiotherapy Oncol. 2010;97:307–11.CrossRef
27.
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.CrossRef
28.
Yasuda S, Kamata H, Machida T, Okada K, Tanaka A, Suzuki T, et al. A case of isolated paraaortic lymph node recurrence from colon cancer successfully treated with chemoradiotherapy. Tokai J Exp Clin Med. 2012;37:47–50.PubMed
29.
Miyazawa T, Ebe K, Koide N, Fujita N. Complete response of isolated para-aortic lymph node recurrence from rectosigmoid cancer treated by chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab: a case report. Case Rep Oncol. 2012;5:216–21.CrossRef
30.
Tsuchiya N, Yamagishi S, Ishibe A, Matsuo K, Misuta K, Nakano A. A case of para-aortic lymph node metastasis from colon cancer with complete response to uracil/tegafur plus leucovorin therapy. Gan Kagaku Ryoho Cancer Chemotherapy. 2014;41:261–3.PubMed
31.
Fujii S, Ota M, Ichikawa Y, Yamagishi S, Osada S, Suwa H, et al. Paraaortic lymph node metastasis showed CR to UFT/LV therapy in elderly rectal cancer. Hepatogastroenterology. 2010;57:472–6.PubMed
32.
Katsumoto Y, Maruyama KT, Furukawa J, Nagai K, Maruyama N, Tanaka J, et al. A case of lymph node metastasis after 7 years from Hartmann's operation for stage IV sigmoid colon carcinoma. Gan Kagaku Ryoho Cancer Chemotherapy. 2004;31:1930–1.PubMed
33.
Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.CrossRef
34.
Hirosawa T, Itabashi M, Ohnuki T, Yamaguchi N, Sugihara K, Kameoka S, Japanese Society for Cancer of the C, Rectum Study Group for Pulmonary Metastases from Colorectal C. Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study. Surg Today. 2013;43:494–9.
35.
Wong JS, Tan GH, Teo MC. Management of para-aortic lymph node metastasis in colorectal patients: a systemic review. Surg Oncol. 2016;25:411–8.CrossRef
36.
Primrose J, Falk S, Finch-Jones M, Valle J, O'Reilly D, Siriwardena A, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol. 2014;15:601–11.CrossRef
37.
Albandar MH, Cho MS, Bae SU, Kim NK. Surgical management of extra-regional lymph node metastasis in colorectal cancer. Expert Rev Anticancer Ther. 2016;16:503–13.CrossRef
38.
Mitry E, Fields AL, Bleiberg H, Labianca R, Portier G, Tu D, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol. 2008;26:4906–11.CrossRef
39.
Nakayama I, Suenaga M, Wakatsuki T, Ichimura T, Ozaka M, Takahari D, et al. Safety, tolerability, and efficacy of oxaliplatin-based adjuvant chemotherapy after curative resection of hepatic or extrahepatic metastases of Stage IV colorectal cancer. Cancer Chemother Pharmacol. 2015;76:133–9.CrossRef
Metadata
Title
Management of isolated para-aortic lymph node recurrence of colorectal cancer
Authors
Kazuhito Sasaki
Hiroaki Nozawa
Kazushige Kawai
Keisuke Hata
Toshiaki Tanaka
Takeshi Nishikawa
Yasutaka Shuno
Manabu Kaneko
Koji Murono
Shigenobu Emoto
Hirofumi Sonoda
Soichiro Ishihara
Publication date
01-09-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 9/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01872-z

Other articles of this Issue 9/2020

Surgery Today 9/2020 Go to the issue

Original Article

Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy

Short Communication

Early implementation of protective measures defines surgical outcomes in the COVID-19 pandemic

Original Article

Utility of the periareolar incision technique for breast reconstructive surgery in patients with breast cancer

Original Article

The novel mechanism of valproate to prevent peritoneal adhesion formation

Original Article

Determining the difference in the efficacy and safety of self-expandable metallic stents as a bridge to surgery for obstructive colon cancer among patients in the CROSS 0 group and those in the CROSS 1 or 2 group: a pooled analysis of data from two Japanese prospective multicenter trials

Review Article

Platelet and liver regeneration after liver surgery