![]() Positron emission tomography (PET) was selectively performed when distant metastasis was suspected. Preoperative evaluation included serum levels of carcinoembryonic antigen (CEA), colonoscopy, abdominopelvic computed tomography (CT), and rectal magnetic resonance imaging. The clinicopathologic factors of the included patients were retrospectively collected through a review of medical records, which included demographic data, preoperative evaluation, operative findings, pathologic characteristics, and postoperative outcomes. Patients without suspected PALNM in the preoperative imaging study were classified into the incidentally detected PALN group. We included all patients with retrieved PALNs regardless of whether or not PALNM was suspected on preoperative radiologic examination. Patients with left-sided colon and rectal cancer who underwent colorectal surgery with PALND were included in this study. This study was approved by the institutional review board of our institution (CNUHH-2020-157). We retrospectively reviewed patients with primary colorectal cancer who underwent surgical resection at our institution between January 2010 and December 2018. Therefore, we designed this study to investigate the probability of pathologic PALNM and the benefit of PALND in patients with enlarged PALNs incidentally detected during colorectal cancer surgery. Moreover, very few studies have been conducted on the treatment strategy for enlarged PALNs incidentally detected during colorectal cancer surgery. Although several studies have shown that PALN dissection (PALND) improves survival in patients with PALNM, there has been no clearly defined standard treatment for PALNM. Previous studies have shown that patients with PALNM have a significantly lower survival rate than those without PALNM. PALNM occurs in approximately 2% of colorectal cancer patients. Īccording to the American Joint Committee on Cancer (AJCC) classification, paraaortic lymph node (PALN) metastasis (PALNM) is categorized as distant metastasis (M1), and therefore stage IV. The 5-year relative survival of colorectal cancer patients of all stages is approximately 67%, whereas the 5-year relative survival of stage IV patients is only 15%. Approximately 22% of patients with colorectal cancer are diagnosed at stage IV. Conclusionĭissection of enlarged PALNs incidentally detected during colorectal surgery may benefit patients with favorable survival outcomes.Ĭolorectal cancer is the third most common cancer in men and the second most common cancer in women, with 1.8 million new cases in 2018 according to the World Health Organization GLOBOCAN database. In patients undergoing R0 resection, pathologic PALNM was not associated with 5-year OS (90% vs. ![]() Pathologic T4 stage (hazard ratio 2.196, 95% CI 1.063–4.538) and R2 resection (HR 4.643, 95% CI 2.046–10.534) were independent prognostic factors for overall survival (OS). Radiologic PALNM (odds ratio 12.737, 95% confidence interval 3.472–46.723) and radiologic distant metastasis other than PALNM (OR = 4.090, 95% CI 1.011–16.539) were independent predictive factors for pathologic PALNM. ![]() These 5 patients accounted for 2.2% of 227 patients who had no evidence of PALNM on preoperative radiologic examination. ResultsĪmong 263 patients included, 19 (7.2%) showed pathologic PALNM and 5 (26.33%) had enlarged PALNs incidentally detected during surgery. The predictive factors for pathologic PALN metastasis (PALNM) were analyzed, and survival analyses were conducted to identify prognostic factors. We retrospectively reviewed patients with left colon and rectal cancer who underwent surgical resection with PALN dissection between January 2010 and December 2018. The purpose of this study was to investigate the benefit of lymph node dissection in patients with incidentally detected enlarged PALNs. Very few studies have been conducted on the treatment strategy for enlarged paraaortic lymph nodes (PALNs) incidentally detected during surgery. ![]()
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