Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Surg Today. 2020 Sep;50(9):947-954. doi: 10.1007/s00595-019-01872-z. Epub 2019 Aug 29.
Isolated para-aortic lymph node recurrence (PALNR) after curative surgery for colorectal cancer (CRC) is rare and its optimal management is not defined clearly. This review investigates the best outcomes among published studies on the management of PALNR in the field of CRC. We searched the PubMed database for studies reporting on the management of isolated PALNR in CRC, published in English or Japanese from January, 2000 to December, 2018. Studies including patients with other metastases were excluded. A total of 24 retrospective studies including 227 patients with PALNR were evaluated. The 3-year overall survival (OS) ranged from 60 to 100%, with a median OS of 34-80 months for patients who underwent PALNR dissection, and 14-42 months for patients who received non-surgical treatment. No surgery-related mortality was reported and the incidence of surgical, mainly low-grade, complications ranged from 33 to 52%. The predictors of improved survival outcome included R0 resection margins. Dissection for PALNR from CRC is considered a feasible treatment option that may yield a better prognosis than non-surgical treatment alone. Preoperative chemotherapy or CRT should be considered for their potential benefits, including a reduction in cancer volume and improved R0 resection rates.
结直肠癌（CRC）根治性手术后孤立性腹主动脉旁淋巴结复发（PALNR）较为罕见，其最佳治疗方法尚不清楚。本综述旨在探讨 CRC 领域中 PALNR 管理的研究中最佳结果。我们检索了 PubMed 数据库，以获取 2000 年 1 月至 2018 年 12 月间发表的关于 CRC 中孤立性 PALNR 管理的英文或日文研究。排除了包括其他转移灶的研究。共评估了 24 项回顾性研究，包括 227 例 PALNR 患者。PALNR 切除术患者的 3 年总生存率（OS）为 60%-100%，中位 OS 为 34-80 个月；而非手术治疗患者的中位 OS 为 14-42 个月。无手术相关死亡病例，手术相关并发症主要为低级别的，发生率为 33%-52%。预测生存结果改善的因素包括 R0 切缘。从 CRC 中进行 PALNR 切除术被认为是一种可行的治疗选择，可能比单纯非手术治疗获得更好的预后。术前化疗或 CRT 应考虑其潜在益处，包括降低肿瘤体积和提高 R0 切除率。
