Gagnière J, Dupré A, Chabaud S, Peyrat P, Meeus P, Rivoire M
Digestive and Hepatobiliary Surgery Department, Estaing University Hospital, 63000 Clermont-Ferrand, France; Digestive Surgery Department, Léon Bérard Cancer Center, 69008 Lyon, France.
Digestive Surgery Department, Léon Bérard Cancer Center, 69008 Lyon, France.
Eur J Surg Oncol. 2015 Jun;41(6):731-7. doi: 10.1016/j.ejso.2015.03.229. Epub 2015 Apr 8.
Retroperitoneal nodal metastases (RNM) represent 1-2% of metastases from colorectal cancer (CRC). Non-surgical treatments achieve 5-year overall survival (OS) of 0-12%. Radical retroperitoneal lymphadenectomy (RRL) in this setting remains controversial, but most published series do not distinguish local retroperitoneal recurrences from RNM. We specifically report outcomes after RRL for RNM from CRC.
We analyzed prospectively recorded data from patients who underwent standardized RRL for RNM from CRC between January 1997 and August 2012 in our institution. Local retroperitoneal recurrences were excluded.
Twenty-five patients underwent RRL for synchronous (n = 19) or metachronous (n = 6) RNM from CRC. Fifteen patients had extra-retroperitoneal metastases. Median hospital stay was 16 [7-23] days. Grade ≥ III morbidity was 8% with no perioperative deaths. Median follow-up was 85 [4-142] months. Median OS and progression free survival (PFS) were 60 [4-142] and 14 [1-116] months. One, three- and 5-year OS were 92%, 64% and 47%. One, three- and 5-year PFS were 51%, 26% and 26%. Retroperitoneal nodal metastases from stage III CRC were associated with better median OS compared to those from stage IV CRC (p = 0.02). This variable did not impact on PFS. Subject to substantial risk of type II error on small samples data statistical analysis, survivals were not affected by timing and location of RNM, extra-retroperitoneal metastasis, nodal disruption, neoadjuvant nor adjuvant chemotherapy.
To our knowledge, this is the largest series yet reported which specifically studied outcomes of RRL for RNM from CRC. RRL allows favorable outcomes in selected patients with acceptable morbidity.
腹膜后淋巴结转移（RNM）占结直肠癌（CRC）转移病例的1%-2%。非手术治疗的5年总生存率（OS）为0%-12%。在这种情况下，根治性腹膜后淋巴结清扫术（RRL）仍存在争议，但大多数已发表的系列研究并未区分局部腹膜后复发和RNM。我们专门报告了CRC患者RNM行RRL后的结果。
我们分析了1997年1月至2012年8月期间在我院接受标准化RRL治疗CRC患者RNM的前瞻性记录数据。排除局部腹膜后复发患者。
25例患者因CRC的同步（n = 19）或异时性（n = 6）RNM接受了RRL。15例患者有腹膜外转移。中位住院时间为16[7-23]天。≥III级并发症发生率为8%，无围手术期死亡。中位随访时间为85[4-142]个月。中位OS和无进展生存期（PFS）分别为60[4-142]个月和14[1-116]个月。1年、3年和5年OS分别为92%、64%和47%。1年、3年和5年PFS分别为51%、26%和26%。与IV期CRC患者的RNM相比，III期CRC患者的腹膜后淋巴结转移的中位OS更好（p = 0.02）。该变量对PFS无影响。由于小样本数据统计分析存在II类错误的重大风险，生存率不受RNM的时间和位置、腹膜外转移、淋巴结破裂、新辅助或辅助化疗的影响。
据我们所知，这是迄今为止报道的最大系列研究，专门研究了CRC患者RNM行RRL的结果。RRL在选定的患者中可获得良好的结果，且并发症发生率可接受。
