Ann Surg Treat Res.  2023 Nov;105(5):271-280. 10.4174/astr.2023.105.5.271.

Multicenter study of prognostic factors in paraaortic lymph node dissection for metastatic colorectal cancer

• Bong JW
• Kang S
• Park P

• KMID: 2547532
• DOI: http://doi.org/10.4174/astr.2023.105.5.271

Abstract

Purpose
The role of paraaortic lymph node dissection (PALND) in colorectal cancer (CRC) has been less evaluated than surgical treatments for other distant metastases. We evaluated surgical outcomes after PALND and identified prognostic factors.
Methods
The medical records of patients who underwent PALND for paraaortic lymph node metastasis (PALNM) were reviewed retrospectively. All patients were categorized into the M1a group (isolated PALNM, n = 27), and the M1bc group (distant metastases other than PALNM, n = 26). Three severity factors (PALNM-SF: number of harvested paraaortic lymph nodes [hLN], ≥14; number of metastatic paraaortic lymph nodes [mLN], ≥5; and lymph nodes ratio [mLN/hLN], ≥0.5) were defined to determine their effects on survival.
Results
The 5-year overall survival (OS) of the M1a and M1bc groups were 61.1% and 6.4%, respectively (P = 0.0013). The 5-year disease-free survival (DFS) of the M1a group was 47.4%, and the 3-year DFS of the M1bc group was 9.1% (P < 0.001). Patients with 2 or more PALNM-SFs showed worse OS than those with 1 PALNM-SF (P = 0.017). In multivariate analysis, M1bc (non-isolated PALNM) was the only significant factor for survival. In the M1a group, patients with 2 or more PALNMSFs showed significantly worse survival than those with a single PALNM-SF. In multivariate analysis, 2 or more PALNM-SF was a significant factor for survival.
Conclusion
PALND for CRC provided favorable outcomes in the survival of an isolated PALNM, although this was uncertain for non-isolated PALNMs. The PALNM-SFs helped assess the prognosis after PALND.

Keyword

Colorectal neoplasms; Lymph node excision; Neoplasm metastasis; Paraaortic lymph nodes; Prognosis

Figure

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  Fig. 1 Surgical areas of paraaortic lymph node dissection. IVC, inferior vena cava.

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  Fig. 2 Disease-free survival and overall survival of patients according to the M category. M1a group, patients with isolated paraaortic lymph node metastasis; M1bc group, patients with paraaortic lymph node metastasis with other distant metastases.

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  Fig. 3 Disease-free survival and overall survival after paraaortic lymph node dissection according to the number of severity factors of paraaortic lymph node metastasis. Severity factors: number of metastatic paraaortic lymph nodes (mLN) of ≥5, number of harvested paraaortic lymph nodes (hLN) of ≥14, and lymph node ratio (LNR; mLN/hLN) of ≥0.5.

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  Fig. 4 Disease-free survival and overall survival of the M1a group according to the number of severity factors of paraaortic lymph node metastasis. M1a group, patients with isolated paraaortic lymph node metastasis. Severity factors: number of metastatic paraaortic lymph nodes (mLN) of ≥5, number of harvested paraaortic lymph nodes (hLN) of ≥14, and lymph node ratio (LNR; mLN/hLN) of ≥0.5.

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