Ann Surg Treat Res.  2016 Jan;90(1):29-35. 10.4174/astr.2016.90.1.29.

Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes

• Song SH
• Park SY
• Park JS
• Kim HJ
• Yang CS
• Choi GS

• KMID: 2149929
• DOI: http://doi.org/10.4174/astr.2016.90.1.29

Abstract

PURPOSE
Treatment of patients with para-aortic lymph node metastasis from colorectal cancer is controversial. The goal of this study was to investigate the technical feasibility of laparoscopic intrarenal para-aortic lymph node dissection in patients with colorectal cancer and clinically suspected para-aortic lymph node dissection.
METHODS
The inclusion criteria for the laparoscopic approach were patients with infrarenal para-aortic lymph node metastasis from colorectal cancer. Patients who had any other distant metastatic lesion or metachronous para-aortic lymph node metastasis were excluded from this study. Perioperative outcomes and survival outcomes were analyzed.
RESULTS
Between November 2004 and October 2013, 40 patients underwent laparoscopic para-aortic lymph node dissection. The mean operating time was 192.3 +/- 68.8 minutes (range, 100-400 minutes) and the mean estimated blood loss was 65.6 +/- 52.6 mL (range, 20-210 mL). No patient required open conversion. The postoperative complication rate was 15.0%. Sixteen patients (40.0%) had pathologically positive lymph nodes. In patients with metastatic para-aortic lymph nodes, the 3-year overall survival rate and disease-free survival rate were 65.7% and 40.2%, respectively.
CONCLUSION
The results of our study suggest that a laparoscopic approach for patients with colorectal cancer with metastatic para-aortic lymph nodes can be a reasonable option for selected patients.

Keyword

Colorectal neoplasms; Neoplasm metastasis; Lymph nodes; Lymph node excision; Laparoscopy

MeSH Terms

Colorectal Neoplasms*
Disease-Free Survival
Humans
Laparoscopy
Lymph Node Excision*
Lymph Nodes*
Neoplasm Metastasis
Postoperative Complications
Survival Rate

Figure

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  Fig. 1 Final operative finding of laparoscopic resection and paraaortic lymph node dissection (66-year-old male patient with pathologically positive paraaortic lymph nodes).

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  Fig. 2 Overall survival (A) and disease-free survival (B) of 40 patients according to tumor stage. (C) Disease-free survival of 16 patients with stage IV tumors (para-aortic lymph node, PALN) according to the number of metastatic PALN.

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