The treatment strategy of R0 resection in colorectal cancer with synchronous para-aortic lymph node metastasis

概要

Synchronous metastatic para-aortic lymph node (mPALN) dissection colorectal cancer has
relatively good oncological outcomes, though many patients develop recurrence. Universal
prognostic factor remain unclear and no definitive perioperative chemotherapy is available,
making the treatment of mPALN controversial. In the present study, we aimed to establish a
treatment strategy for synchronous mPALN. This retrospective study involved 20 patients with
pathological mPALN below the renal vein who underwent R0 resection. Long-term outcomes,
recurrence type, and prognostic factors for survival were investigated. The 5-year overall survival
and recurrence-free survival rates were 39% and 25%, respectively. Seventeen patients (85%)
developed recurrence, including 13 (76%) within 1 year after surgery, and ~ 70% of all
recurrences were multiple recurrences. Four patients (20%) survived > 5 years. Pathological T
stage ( p = 0.011), time to recurrence ( p = 0.007), and recurrence resection ( p = 0.009) were
identified as prognostic factors for long-term survival.
R0 resection of synchronous mPALN in colorectal cancer resulted in acceptable oncological
outcomes, though we found a high rate of early unresectable recurrence. If the recurrence occurs
late or isolated, surgical resection should be considered for longer survival. ...

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