Ann Surg Treat Res.  2020 Mar;98(3):130-138. 10.4174/astr.2020.98.3.130.

Management of isolated para-aortic lymph node recurrence after surgery for colorectal cancer

• Kim YI
• Park IJ
• Park JH
• Kim TW
• Ro JS
• Lim SB
• Yu CS
• Kim JC

• KMID: 2471178
• DOI: http://doi.org/10.4174/astr.2020.98.3.130

Abstract

PURPOSE
The rare incidence of isolated para-aortic lymph node (PALN) recurrence of colorectal cancer has precluded the formulation of treatment guidelines. This study evaluated and compared the effects of different treatment modalities on survival outcomes in patients with PALN recurrence.
METHODS
Patients diagnosed with isolated PALN recurrence after curative resection for primary colorectal cancer from January 2004 to December 2014 were evaluated retrospectively. Patients with isolated recurrence were selected using imaging modalities. Overall survival (OS) and survival after recurrence (SAR) were analyzed and compared between different treatments using the Kaplan-Meier method.
RESULTS
The median OS was 64 months with a median follow-up time of 50 months. Of the 46 patients with PALN recurrence, 35 (76.1%) had isolated recurrences. Of these 35 patients, 16 underwent PALN resection and 19 received chemotherapy. Median SAR was significantly longer in patients who did than did not undergo resection (71 months vs. 39 months, P = 0.017). Median OS tended to be longer in patients who did than did not undergo resection (77 months vs. 62 months, P = 0.055). SAR was similar in patients who received radiotherapy and those who underwent resection (34 months vs. 46 months, P = 0.146). Three of 16 patients (18.8%) who underwent resection were found to be recurrence-free.
CONCLUSION
Surgical resection of isolated PALN recurrence may benefit patients, with favorable survival outcomes and by providing definitive diagnosis for proper treatment planning.

Keyword

Colorectal neoplasms; Lymph node excision; Mortality; Para-aortic lymph node

MeSH Terms

Colorectal Neoplasms*
Diagnosis
Drug Therapy
Follow-Up Studies
Humans
Incidence
Lymph Node Excision
Lymph Nodes*
Methods
Mortality
Radiotherapy
Recurrence*
Retrospective Studies

Figure

• 

  Fig. 1 (A) CT image and PET image of patient number 5 (Table 5). Short axis diameter of 17 mm, single cluster recurrent paraaortic lymph node (PALN) in CT image (white arrow), and correlating single high standard uptake value in PET image (black arrow) indicates possibility of resection. (B) CT and PET images of an unresectable patient. Multiple PALN between aorta and inferior vena cava with additional lymph nodes below kidney level shown in CT image (yellow uptake), with correlating multiple scattered high standard uptake value shown in PET image.

• 

  Fig. 2 Kaplan-Meier analysis of survival after recurrence rates in patients who did and did not undergo resection for resectable recurrent para-aortic lymph node (PALN) (n = 35). Survival after recurrence rate was higher in the resected group, with a hazard ratio (HR) of 0.379. CI, confidence interval.

• 

  Fig. 3 Kaplan-Meier analysis of overall survival rates in patients who did and did not undergo resection for resectable recurrent para-aortic lymph node (PALN) (n = 35). Overall survival rate was higher in the resected group, with a hazard ratio (HR) of 0.455. CI, confidence interval.

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