Introduction Isolated paraaortic lymph-node recurrence (IPLNR) accounts for one percent of recurrent disease following colorectal cancer resection. We present a case series of patients in whom paraaortic lymphadenectomy for IPLNR following colorectal cancer was performed along with a systematic review of existing literature.
Method Patients who underwent a metachronous paraaortic lymphadenectomy for IPLNR were identified retrospectively from a prospectively collected colorectal cancer database between 2005 and 2011. Demographics, surgical morbidity and long term outcome and survival were extracted.
A systematic review of the literature was undertaken using three electronic databases, PUBMED, EMBASE and Google scholar following PRISMA guidelines. Additional papers were extracted from manual searches of the references.
Results From the local colorectal cancer database four patients who underwent metachronous IPLNR lymphadenectomy were included. The median follow up of these patients was 20.3 months (interquartile range (IQR) 12.5–29.6 months). There were no perioperative morbidity or deaths in this cohort. One out of four patients (25%) experienced a rerecurrence at 31 months and was treated with CyberKnifeTM. All patients were still alive at the end of the follow up period.
Following systematic review, seven published studies were analysed. Further analysis included the four patients in this case series and 110 patients identified through systematic review (n = 114).
Overall, the median follow up following surgery was 29.5 months (IQR 26.8–31.0 months). Of these patients, there were no perioperative deaths and 22 patients (19%) experienced major perioperative complications including bleeding, ileus and wound infection.
Recurrences following lymphadenectomy were experienced by 64% (73/114) of patients. In those studies (5 studies) that reported 5 year overall survival, the overall survival was 50% (51/102).
Conclusion The morbidity and mortality following lymphadenectomy for IPLNR is low. In carefully selected patients surgical intervention for IPLNR may be associated with improved longer term survival similar to the results seen after hepatic resection.
Disclosure of interest None Declared.
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