Sung Uk Bae1,2, Yoon Dae Han2, Min Soo Cho2, Hyuk Hur2, Byung Soh Min2, Seung Hyuk Baik2, Kang Young Lee2, Nam Kyu Kim3. 1. Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea. 2. Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 3. Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yuhs.ac.
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.
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 metastasispatients 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.
Authors: Sung Uk Bae; Hyuk Hur; Byung Soh Min; Seung Hyuk Baik; Kang Young Lee; Nam Kyu Kim Journal: Cancer Res Treat Date: 2017-07-14 Impact factor: 4.679