Surgical roles in the management of metachronus para-aortic lymph node recurrence and synchronous para-aortic lymph node metastasis in colorectal cancer patients

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)

Papel de la linfadenectomía paraaórtica inframesentérica durante la histerectomía radical en pacientes con cáncer cervical estadio IB1 en el Instituto Nacional de Cancerología Bogotá, Colombia / Role of inframesenteric para-aortic lymphadenectomy during radical hysterectomy in patients with IB1 cervical cancer in Instituto Nacional de Cancerología Bogota, Colombia

INTRODUCCIÓN: El cáncer cervical es una patología común en países en vías de desarrollo. La histerectomía radical es el estándar de manejo en estadios tempranos sin deseo de fertilidad. La linfadenectomía paraaórtica como parte del tratamiento quirúrgico es controversial. El objetivo de este estudio es determinar la frecuencia de compromiso ganglionar paraaórtico en una serie retrospectiva de pacientes con carcinoma cervical estadio IB1 (clasificación FIGO 2009) llevadas a histerectomía radical mas linfadenectomía pélvica y paraaórtica en el Instituto Nacional de Cancerología durante el periodo de enero 1 de 2009 a marzo 31 de 2017. MÉTODOS: Estudio descriptivo, retrospectivo. Se describieron variables clínicas, operatorias e histopatológicas. Se determinó la frecuencia de compromiso ganglionar a nivel paraaórtico o pélvico, y concurrente. Se realizó análisis univariado en el software estadístico R Project versión 3.6.0. RESULTADOS: Se incluyeron 88 casos. El promedio de edad fue 44,24 ± 9,99 años. La mediana del número de ganglios pélvicos y paraaórticos resecados fue de 23 (6-68) y 4 (1-25), respectivamente. En el 12,5% de las pacientes se observó compromiso tumoral ganglionar pélvico. No se detectó compromiso metastásico de ganglios paraórticos en ningún caso. Dos pacientes presentaron recaída ganglionar paraaórtica durante el seguimiento, recibiendo tratamiento con quimioterapia y quimiorradioterapia de campo extendido, respectivamente. CONCLUSIÓN: En este estudio no se detectó compromiso paraaórtico en pacientes con cáncer cervical IB1 sometidas a histerectomía radical. Este resultado se debe considerar al ofrecer linfadenectomía paraaórtica en pacientes con ganglios pélvicos aparentemente normales en el acto operatorio y/o en los estudios de imágenes prequirúrgicas.

INTRODUCTION: Cervical cancer is a common pathology in developing countries. Radical hysterectomy is the standard of management in early stages without desire for fertility. Paraaortic lymphadenectomy as part of surgical treatment is controversial. The objective of this study is to determine the frequency of paraaortic lymph node involvement in a retrospective series of patients with stage IB1 cervical carcinoma (FIGO 2009 classification) underwent to radical hysterectomy plus pelvic and paraaortic lymphadenectomy at the Instituto Nacional de Cancerologia during the period of January 1 2009 to March 31 2017. METHODS: Descriptive, retrospective study. Clinical, operative, and histopathological variables were described. The frequency of paraaortic, pelvic, concurrent lymph node involvement and adjuvant treatment was determined. A univariate analysis of the variables was performed in the R project statistical software version 3.6.0. RESULTS: 88 cases were included. The mean age was 44,24 ± 9,99 years. The median number of resected pelvic and para-aortic nodes was 23 (6-68) and 4 (1-25), respectively. In 12,5 % of the patients, involvement of the pelvic lymph nodes was present. No patient had paraaortic lymph node involvement. Two patients presented para-aortic lymph node relapse during follow-up, receiving treatment with chemotherapy and extended field chemoradiotherapy, respectively. CONCLUSION: In this study, the frequency of paraaortic involvement in patients with cervical cancer IB1 was 0%. This result should be considered when offering paraaortic lymphadenectomy in patients with apparently normal pelvic nodes in presurgical imaging studies and during the procedure.

Surgical Treatment of Gastroesophageal Junction Cancer

Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.

Analysis of Paraaortic lymph Nodes Involvment in Pancreatic Carcinoma by Spiral Computer Tomegmphy / 医学研究杂志

11 mm) and presence of central necrosis are the suggestive morphologic features of metastatic paraaortic nodes.

Ten Year Disease-free Survival of a Patient after Modified Hepatoligamentopancreatoduodenectomy for Diffuse Hilar Cholangiocarcinoma with Paraaortic Lymph Node Metastases: A Case Report

A 39-year-old female patient presenting with epigastric discomfort and jaundice was diagnosed as diffuse hilar cholangiocarcinoma with vascular tumor invasion. After preoperative management with percutaneous transhepatic biliary drainage and right portal vein embolization, the patient underwent modified hepatoligamentopancreatoduodectomy; this included extended right hepatectomy, caudate lobectomy, portal vein segmental resection, enbloc resection of hepatoduodenal ligament together with proper hepatic artery resection and with leaving a replaced left hepatic artery from the left gastric artery, and paraaortic lymph node dissection. Intraoperative frozen histologic examination revealed multiple paraaortic lymph node metastases, which was generally regarded as definite distant metastasis. There was no postoperative complication except for persistent drainage of ascites that occurred only during the immediate postoperative period. She did not receive postoperative adjuvant chemotherapy or radiotherapy. The patient is now living well 11 years 2months after surgery without recurrence. Although this patient revealed hilar vascular invasion and paraaortic lymph node metastasis, she survived more than 10 years without tumor recurrence. This implicate that aggressive surgical treatment of hilar cholangiocarcinoma can result in long-term survival even in the presence of paraaortic lymph node metastasis.

Comparison of Clinical Outcome in Para-aortic Lymph Node Dissection (PALD) and D2 for Advanced Gastric Cancer / 대한암학회지

PURPOSE: We compared the clinical results of paraaortic lymph node dissection (PALD) with those of D2 to evaluate the survival gain and disadvantage of paraaortic lymph node dissection for advanced gastric cancer. MATERIALS AND METHODS: We analysed the clinical data of 196 patients who underwent curative resection and D2 with or without paraaortic lymph node dissection (PALD or D2) for advanced gastric cancer from May 1990 to June 1999. The operative factors (operative time, the amounts of intraoperative transfusion and hospital stay), operative morbidity and mortality and 5 year survival rates were compared between D2 and PALD groups. RESULTS: The operative time of subtotal gastrectomy was significantly longer in PALD group than D2 group. The operative morbidity rates were 9.2% in D2 group and 10.3% in PALD group. There were 3 operative mortalities in D2 group and none in PALD group. The 5 year survival rates (5YSR's) of stage IB, II, IIIA, IIIB, IV were 88.9%, 92.3%, 30.2%, 24.2%, 28.9% in D2 group and 93.3%, 75.5%, 61.0%, 0%, 0% in PALD group. CONCLUSION: The paraaortic lymph node dissection was a rather safe procedure without significant increase of morbidity and mortality. There was no statistically significant difference in survival in any stage of this retrospective study with limited cases and follow-ups.

The Results of Hyperfractionated Radiation Therapy Combined with Taxol for Paraaortic Node Recurrence in Cervix Cancer / 대한방사선종양학회지

PURPOSE: The aim of this study was to investigate treatment results, toxicity and efficacy of hyperfractionated radiation therapy combined with paclitaxel for paraaortic node recurrence in cervix cancer. MATERIALS AND METHODS: Between September 1997 to March 1999, 12 patients with paraaortic node recurrence in cervix cancer who previously received radical or postoperative radiotherapy were treated with hyperfractionated radiation therapy combined with paclitaxel. Of these, 2 patients who irradiated less than 30 Gy were excluded, 10 patients were eligible for this study. Median age was 5 1 years. Initial FlGO stage was 1 stage IB1, 2 stage IIA, 7 stage IIB. For initial treatment, 7 patients received radical radiotherapy and 3 received postoperative radiotherapy. The paraaortic field encompassed the gross recur rent disease with superior margin at T 12, and inferior margin was between L5 and S 1 with gap for previously pelvic radiation field. The radiation field was initially anterior and posterior opposed field followed by both lateral field. The daily dose was 1.2 Gy, twice daily fractions, and total radiotherapy dose was between 50.4 and 60 Gy(median, 58.8 Gy). Concurrent chemotherapy was done with paclitaxel as a radiosensitizer. Dose range was from 20 mg/m to 30 mg/m (median, 25 mg/m'), and cycle of chemotherapy was from 3 to 6 (median, 4.5 cycle). Follow-up period ranged from 3 to 21 months. RESULTS: Interval between initial diagnosis and paraaortic node recurrence was range from 2 to 63 months (median, 8 months). The 1 year overall survival rate and median survival were 75% and 9.5 months, respectively. The 1 year disease free survival rate and median disease free survival were 30% and 3 7 months, respectively. At 1 month after treatment, 4 (40%) achieved a complete response and 6 (63%) experienced a partial response and all patients showed response above the partial response. There was distant metastasis in 6 patients and pelvic node recurrence in 2 patients after paraaortic node irradialion. There was 2 patients with grade 3 to 4 leukopenia and 8 patients with grade 1 to 2 nausea/ vom ting which was usually tolerable with antiemetic drug. There was no chronic complication in abdomen and pelvis during follow up period. CONCLUSION: Hyperfractionated radiation therapy combined with paclitaxel as a radiosensitizer showed high response rate and few complication rate in paraaortic node recurrence in cervix cancer. Therefore, present results suggest that hyperfractionated radiation therapy combined with paclitaxel chemotherapy can be used as optimal treatment modality in this patients.

Clinical Results of Para-aortic Lymph Node Dissection in Advanced Gastric Cancer / 대한암학회지

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data. MATERIALS AND METHODS: The authors analyzed retrospectively pathological features of 95 patients who underwent paraaortic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation from May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unknown causes of death in survival analysis. RESULTS: The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSR's) in relation to the paraaortic lymph node (No16) status was 0.0% in No16 , and 57.8% in No16 with D4 of advanced gastric cancer. The 5 YSR's were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, n1, n2 and n3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively. CONCLUSION: The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Borrmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p<0.05).

Granisetron in the Prevention of Nausea and Vomiting in Patients Receiving Platinum - Containing Chemotherapy / 대한암학회지

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data. MATERIALS AND METHODS: The authors analyzed retrospectively pathological features of 95 patients who underwent paraacntic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation Bom May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unlmown causes of death in survival analysis. RESULTS: The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSRs) in relation to the paraaortic lymph node (No16) status was 0.096 in No16+, and 57.8Po in Nol6 with D4 of advanced gastric cancer. The 5 YSRs were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, nl, n2 and n.3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively. CONCLUSION: The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Bonmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p < 0.05).