Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.
Department of Upper GI Surgery, Salford Royal Foundation Trust, Northern Care Alliance, Stott Ln, Salford, M6 8HD, UK.
Langenbecks Arch Surg. 2023 Dec 13;409(1):4. doi: 10.1007/s00423-023-03185-9.
Para-aortic lymph node metastasis associated with colorectal cancer is a very rare occurrence, but at the same time an important predictor of survival. Despite its importance, there is still no gold standard management strategy, particularly for lymph nodes detected during follow-up, after resection of the primary tumour. Therefore, this review was undertaken to examine the evidence available on the surgical and non-surgical management of metachronous para-aortic lymph node metastasis (m-PALNM) in colorectal cancer treatment.
This is a systematic review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using Cochrane, MEDLINE, EMBASE and PubMed databases with the following MeSH terms: lymph node excision, para-aortic lymph node, metastasis, metachronous and colorectal neoplasms.
Five original papers met the study criteria including 188 patients in total (55.3% male, 44.7% female). Surgical resection of the m-PALND was the management of choice in 64% of patients. Reporting styles on survival outcomes were heterogeneous. However, patients undergoing surgical management for m-PALNM had longer disease-free survival and overall survival rates.
There is significant paucity in the evidence available on the management of m-PALNM. However, the evidence reported by this review suggests that surgical management should be considered whenever possible, with the aim of prolonging survival. Future randomised trials are needed in order to provide further high-level evidence on m-PALNM management.
结直肠癌的腹主动脉旁淋巴结转移极为罕见，但同时也是一个重要的生存预后指标。尽管其意义重大，但目前仍没有标准的治疗策略，尤其是对于原发性肿瘤切除后随访中发现的淋巴结。因此，我们进行了这项综述，旨在探讨结直肠癌治疗中，对于检测到的腹主动脉旁淋巴结转移（m-PALNM）的手术和非手术治疗方法的现有证据。
这是一项系统综述，使用了患者、干预、比较、结局和研究策略。文献检索使用了 Cochrane、MEDLINE、EMBASE 和 PubMed 数据库，并使用了以下 MeSH 术语：淋巴结切除、腹主动脉旁淋巴结、转移、异时性和结直肠肿瘤。
共有 5 篇原始论文符合研究标准，共纳入 188 例患者（男性占 55.3%，女性占 44.7%）。64%的患者选择手术切除 m-PALND。然而，对于生存结局的报道方式存在很大的异质性。但接受 m-PALNM 手术治疗的患者具有更长的无病生存率和总生存率。
目前对于 m-PALNM 的治疗证据非常有限。然而，本综述报道的证据表明，只要有可能，手术治疗应该被考虑，以延长患者的生存时间。未来需要进行随机对照试验，以提供关于 m-PALNM 管理的进一步高级别证据。
