Bae Sung Uk, Han Yoon Dae, Cho Min Soo, Hur Hyuk, Min Byung Soh, Baik Seung Hyuk, Lee Kang Young, Kim Nam Kyu
Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea.
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2016 May;23(5):1562-8. doi: 10.1245/s10434-015-5027-9. Epub 2015 Dec 29.
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.
From March 2000 to December 2009, the study group included 1082 patients who underwent curative surgery for colonic adenocarcinoma with pathological lymph node metastasis.
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).
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.
对于术前诊断为结肠癌腹主动脉旁淋巴结转移（PALNM）的患者，扩大淋巴结清扫术的治疗策略及获益仍存在高度争议。在本研究中，我们分析了接受区域外淋巴结清扫术治疗孤立性PALNM结肠癌患者的肿瘤学结局。
2000年3月至2009年12月，研究组包括1082例行结肠癌根治性手术且伴有病理淋巴结转移的患者。
在1082例行结肠癌根治性手术的患者中，953例（88.1%）接受了区域淋巴结清扫术，129例（11.9%）接受了腹主动脉旁淋巴结清扫术。病理检查显示N1期疾病738例（68.2%），N2期295例（27.3%），PALNM 49例（4.5%）。区域淋巴结转移组的5年总生存率（OS）和无病生存率（DFS）显著优于PALNM组（OS 75.1%对33.9%，p<0.001；DFS 66.2%对26.5%，p<0.001）。接受根治性切除的PALNM患者与可切除肝转移患者的5年OS和DFS无显著差异（OS 33.9%对38.7%，p=0.080；DFS 26.5%对27.6%，p=0.604）。
结肠癌中的PALNM与区域淋巴结转移相比生存较差，与肝转移切除术的生存率相当。需要进一步研究评估对于潜在可切除PALNM患者， upfront化疗与初始切除相比的净获益。
