van Dorp Martijn, Bousema Jelle Egbert, Torensma Bart, Dickhoff Christian, van den Broek Frank Jozef Christiaan, Schreurs Wilhelmina Hendrika, Gonzalez Michel, Kazemier Geert, Heineman David Jonathan
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
Máxima MC, Department of Surgery, De Run, 4600, Veldhoven, the Netherlands.
Eur J Surg Oncol. 2022 Jan;48(1):253-260. doi: 10.1016/j.ejso.2021.09.020. Epub 2021 Oct 11.
Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However, evidence supporting lymphadenectomy is limited. The aim of this study was to perform a systematic review of the literature on the impact of simultaneous lymph node metastases on patient survival during metastasectomy for colorectal pulmonary metastases (CRPM).
A systematic review was conducted according to the PRISMA guidelines of studies on lymphadenectomy during pulmonary metastasectomy for CRPM. Articles published between 2000 and 2020 were identified from Medline, Embase and the Cochrane Library without language restriction. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the risk of bias and applicability of included studies. Survival rates were assessed and compared for the presence and level of nodal involvement.
Following review of 8054 studies by paper and abstract, 27 studies comprising 3619 patients were included in the analysis. All patients included in these studies underwent lymphadenectomy during pulmonary metastasectomy for CRPM. A total of 690 patients (19.1%) had simultaneous lymph node metastases. Five-year overall survival for patients with and without lymph node metastases was 18.2% and 51.3%, respectively (p < .001). Median survival for patients with lymph node metastases was 27.9 months compared to 58.9 months in patients without lymph node metastases (p < .001). Five-year overall survival for patients with N1 and N2 lymph node metastases was 40.7% and 10.9%, respectively (p = .064).
Simultaneous lymph node metastases of CRPM have a detrimental impact on survival and this is most apparent for mediastinal lymph node metastases. Therefore, lymphadenectomy during pulmonary metastasectomy for CRPM can be advised to obtain important prognostic value.
近期的几次专家共识会议建议，在结直肠癌肺转移灶切除术中常规进行淋巴结清扫。然而，支持淋巴结清扫的证据有限。本研究的目的是对关于同时性淋巴结转移对结直肠癌肺转移（CRPM）患者在转移灶切除术中生存影响的文献进行系统综述。
根据PRISMA指南，对CRPM肺转移灶切除术中淋巴结清扫的研究进行系统综述。从Medline、Embase和Cochrane图书馆中检索2000年至2020年发表的文章，无语言限制。使用推荐分级评估、制定和评价（GRADE）框架来评估纳入研究的偏倚风险和适用性。根据淋巴结受累情况和程度评估并比较生存率。
通过阅读论文和摘要对8054项研究进行综述后，分析纳入了27项研究，共3619例患者。这些研究中纳入的所有患者在CRPM肺转移灶切除术中均进行了淋巴结清扫。共有690例患者（19.1%）存在同时性淋巴结转移。有和无淋巴结转移患者的5年总生存率分别为18.2%和51.3%（p <.001）。有淋巴结转移患者的中位生存期为27.9个月，而无淋巴结转移患者为58.9个月（p <.001）。N1和N2淋巴结转移患者的5年总生存率分别为40.7%和10.9%（p = 0.064）。
CRPM的同时性淋巴结转移对生存有不利影响，这在纵隔淋巴结转移中最为明显。因此，建议在CRPM肺转移灶切除术中进行淋巴结清扫以获得重要的预后价值。
