Ouchi Akira, Komori Koji, Ito Sono, Kinugasa Yusuke, Ishihara Soichiro, Shiomi Akio, Kanemitsu Yukihide, Suto Takeshi, Takahashi Hiroki, Ajioka Yoichi
Department of Gastroenterological Surgery Aichi Cancer Center Hospital Nagoya Japan.
Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan.
Ann Gastroenterol Surg. 2025 Apr 3;9(5):997-1007. doi: 10.1002/ags3.70019. eCollection 2025 Sep.
There is a lack of compelling evidence supporting the benefit of surgical resection for para-aortic lymph node metastasis (PALNM) from colorectal cancer (CRC). We aimed to investigate the true impact of surgical resection on survival for patients with PALNM from CRC.
Patients diagnosed with PALNM from CRC at the Japanese Society for Cancer of the Colon and Rectum institutions between January 2011 and December 2015 were analyzed. Those who had received surgical resection and those who did not were matched one-on-one by the propensity score (PS)-matching method. A total of 77 PS-matched pairs extracted from 347 patients at 36 institutions were compared.
Thirty-one (40.3%) patients each in the surgical resection and chemotherapy groups had distant metastasis other than PALNM, and the most dominant organ was the liver in 18 (23.4%) patients in both groups. In the surgical resection group, 56 (72.7%) patients achieved curative resection of all disease lesions, of which 49 (63.6%) were R0 resection. Three- and 5-year relapse-free survival of patients who achieved curative resection were 24.4% and 24.4%, respectively. Three- and 5-year overall survival (OS) of patients in the surgical resection were 68.4% and 40.2%, which were significantly better than that in the chemotherapy groups (40.9% and 27.7%), respectively (Log-rank = 0.003).
The OS of patients with surgical resection for PALNM was significantly better than those without surgical resection. These results highlight the benefit of surgical intervention to survival for patients with resectable PALNM.
缺乏有力证据支持手术切除对结直肠癌（CRC）腹主动脉旁淋巴结转移（PALNM）的益处。我们旨在研究手术切除对CRC伴PALNM患者生存的真正影响。
分析2011年1月至2015年12月期间在日本结直肠癌学会机构被诊断为CRC伴PALNM的患者。接受手术切除的患者和未接受手术切除的患者通过倾向评分（PS）匹配法进行一对一匹配。比较了从36家机构的347例患者中提取的77对PS匹配对。
手术切除组和化疗组各有31例（40.3%）患者除PALNM外有远处转移，两组中最主要的转移器官均为肝脏，各有18例（23.4%）患者。手术切除组中，56例（72.7%）患者实现了所有疾病病灶的根治性切除，其中49例（63.6%）为R0切除。实现根治性切除的患者3年和5年无复发生存率分别为24.4%和24.4%。手术切除组患者的3年和5年总生存率（OS）分别为68.4%和40.2%，显著优于化疗组（分别为40.9%和27.7%）（对数秩检验=0.003）。
手术切除治疗PALNM患者的OS显著优于未手术切除的患者。这些结果凸显了手术干预对可切除PALNM患者生存的益处。
