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结直肠癌肾下后腹膜淋巴结转移的外科治疗。

Surgery for Infrarenal Retroperitoneal Node Metastases from Colon Cancer.

机构信息

Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Oncologic Surgery, Ambroise-Paré Hospital, 9 Avenue Charles de Gaulle - 92104, Boulogne-Billancourt, France.

Institut Curie, Versailles Saint-Quentin University - Paris Saclay University, Saint-Cloud, France.

出版信息

J Gastrointest Cancer. 2024 Sep;55(3):1306-1312. doi: 10.1007/s12029-024-01086-8. Epub 2024 Jul 2.


DOI:10.1007/s12029-024-01086-8
PMID:38954189
Abstract

PURPOSE: Treatment of retroperitoneal lymph node metastases (RPN) from colon cancer (CC) is a therapeutic challenge. Available evidence supporting a curative approach is weak and uncertainties remain concerning the extent of the dissection, the optimal timing for surgery, and the role of adjuvant radiotherapy. We report the outcomes of a curative intent strategy in a recent monocentric series of patients. METHODS: We did a retrospective review of all curative intent surgical treatment of RPN from CC performed consecutively in a French university hospital from June 2015 to April 2021. Demographics, clinicopathological, and molecular characteristics were evaluated. We describe recurrence-free and overall survival and factors related to recurrence. RESULTS: Records from 18 patients were reviewed. The median age was 69 years. Most of the patients were male (55%), ASA 1-2 (94%), had a left-sided primary colon cancer (73%), and had metachronous RPN (62%). Thirteen patients (72%) experienced recurrence. Recurrence was often limited to RPN (27%) or liver (22%). Four patients underwent a second surgery for RPN recurrence. Median disease-free and overall survival were 22 months and 50 months after RPN surgery. We did not find any factor associated with recurrence. Short-term recurrence (< 6 months) was associated with shorter overall survival (0.031). CONCLUSION: The current results suggest that RPN resection is feasible and associated with long survival in selected patients. Further studies evaluating the benefit of curative strategies including radical surgery for patients with potentially resectable RPN are warranted.

摘要

目的:治疗结肠癌(CC)的腹膜后淋巴结转移(RPN)是一个治疗挑战。目前支持根治性方法的证据较弱,对于手术的范围、手术的最佳时机以及辅助放疗的作用仍存在不确定性。我们报告了最近在一个单中心系列患者中采用根治性策略的结果。

方法:我们回顾了 2015 年 6 月至 2021 年 4 月期间在一家法国大学医院连续进行的所有根治性手术治疗 CC 引起的 RPN 的患者。评估了人口统计学、临床病理和分子特征。我们描述了无复发生存和总生存以及与复发相关的因素。

结果:共回顾了 18 例患者的记录。中位年龄为 69 岁。大多数患者为男性(55%),ASA 1-2 级(94%),左侧原发性结肠癌(73%),且为 RPN 同时性转移(62%)。13 例(72%)患者出现复发。复发通常局限于 RPN(27%)或肝脏(22%)。4 例患者因 RPN 复发而接受第二次手术。RPN 手术后 22 个月和 50 个月的无病生存率和总生存率分别为 22 个月和 50 个月。我们没有发现任何与复发相关的因素。短期复发(<6 个月)与总生存时间缩短相关(0.031)。

结论:目前的结果表明,在选定的患者中,RPN 切除是可行的,并且与长期生存相关。需要进一步研究评估包括根治性手术在内的根治策略对具有潜在可切除 RPN 的患者的获益。

相似文献

[1]
Surgery for Infrarenal Retroperitoneal Node Metastases from Colon Cancer.

J Gastrointest Cancer. 2024-9

[2]
Oncologic Outcomes of Colon Cancer Patients with Extraregional Lymph Node Metastasis: Comparison of Isolated Paraaortic Lymph Node Metastasis with Resectable Liver Metastasis.

Ann Surg Oncol. 2016-5

[3]
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Int J Colorectal Dis. 2017-7

[4]
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Dis Colon Rectum. 2022-3-1

[5]
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J Urol. 2003-4

[6]
Patterns of Clinical Recurrence of Node-positive Prostate Cancer and Impact on Long-term Survival.

Eur Urol. 2015-5-8

[7]
Curative-intent surgery for isolated locoregional recurrence of colon cancer: Review of the literature and institutional experience.

Eur J Surg Oncol. 2020-9

[8]
Reoperative retroperitoneal lymph node dissection for metastatic germ cell tumors: analysis of local recurrence and predictors of survival.

J Urol. 2014-6

[9]
Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer.

PLoS One. 2020

[10]
D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer.

Dis Colon Rectum. 2013-7

本文引用的文献

[1]
Laparoscopic Salvage Surgery for Infrarenal Para-aortic Lymph Node Recurrence of Rectal Cancer.

Dis Colon Rectum. 2024-2-1

[2]
Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review.

Cancers (Basel). 2023-10-24

[3]
Stage IV Colorectal Cancer Management and Treatment.

J Clin Med. 2023-3-6

[4]
Survival benefits of para-aortic lymphadenectomy in colorectal cancer with clinically suspected para-aortic lymph node metastasis: a meta-analysis and systematic review.

World J Surg Oncol. 2023-1-31

[5]
The management of clinically suspicious para-aortic lymph node metastasis in colorectal cancer: A systematic review.

Asia Pac J Clin Oncol. 2023-12

[6]
Oligometastatic Colorectal Cancer: A Review of Definitions and Patient Selection for Local Therapies.

J Gastrointest Cancer. 2023-12

[7]
Contemporary Outcomes for the Curative Treatment of Colorectal Cancer Pulmonary Metastases.

J Gastrointest Cancer. 2023-12

[8]
Survival outcomes after synchronous para-aortic lymph node metastasis in colorectal cancer: A systematic review.

J Surg Oncol. 2023-3

[9]
Effect of radical lymphadenectomy in colorectal cancer with para-aortic lymph node metastasis: a systematic review and meta-analysis.

BMC Surg. 2022-5-14

[10]
Para-aortic lymph node dissection in left-sided colorectal cancer: Risk factors, prognostic impact, and therapeutic value.

J Surg Oncol. 2022-6

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