Kim Young Il, Park In Ja, Park Jin-Hong, Kim Tae Won, Ro Jun-Soo, Lim Seok-Byung, Yu Chang Sik, Kim Jin Cheon
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2020 Mar;98(3):130-138. doi: 10.4174/astr.2020.98.3.130. Epub 2020 Feb 28.
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.
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.
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.
Surgical resection of isolated PALN recurrence may benefit patients, with favorable survival outcomes and by providing definitive diagnosis for proper treatment planning.
结直肠癌孤立性主动脉旁淋巴结（PALN）复发的发生率很低，这使得治疗指南难以制定。本研究评估并比较了不同治疗方式对PALN复发患者生存结局的影响。
回顾性评估2004年1月至2014年12月因原发性结直肠癌接受根治性切除术后诊断为孤立性PALN复发的患者。采用影像学方法筛选出孤立性复发患者。使用Kaplan-Meier方法分析并比较不同治疗方式之间的总生存期（OS）和复发后生存期（SAR）。
中位OS为64个月，中位随访时间为50个月。在46例PALN复发患者中，35例（76.1%）为孤立性复发。在这35例患者中，16例行PALN切除术，19例接受化疗。接受切除术的患者中位SAR显著长于未接受切除术的患者（71个月对39个月，P = 0.017）。接受切除术的患者中位OS倾向于更长（77个月对62个月，P = 0.055）。接受放疗的患者与接受切除术的患者的SAR相似（34个月对46个月，P = 0.146）。16例行切除术的患者中有3例（18.8%）无复发。
手术切除孤立性PALN复发可能使患者受益，具有良好的生存结局，并可为合理的治疗规划提供明确诊断。
