Prophylactic para-aortic lymph node dissection in Colo-rectal cancer; pilot study

IF 2.5 3区医学 Q3 ONCOLOGY

World Journal of Surgical Oncology Pub Date : 2024-09-19 DOI:10.1186/s12957-024-03515-1

Abdalwahab R. Abdalwahab, Mohamed A. Abdelhamed, Mai Gad, Rasha Mahmood Allam, Alaadin Hussien

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Abstract

Colorectal cancer is the 3rd most common cancer worldwide, representing 10% of all cancer types, and is considered the 2nd leading cause of cancer-related deaths. It usually metastasizes to the liver or lung. Para-aortic lymph node metastasis is considered a metastatic disease (stage 4) according to the AJCC and is considered a regional disease (stage 3) according to the JSCCR. Para-aortic lymph node metastases occur in about 1% of cases. Neoadjuvant CTH, followed by PALN, is the best option for metastatic para-aortic LNs in colorectal cancer patients. This study addresses the value of prophylactic para-aortic LN dissection among colon-rectal cancer patients (overtreatment protocol). This is a prospective study that included patients attending NCI, Cairo University, from December 2020 to December 2023 who were complaining of left colonic cancer or recto-sigmoid cancer and underwent left hemicolectomy, sigmoid colectomy, or LAR. All patients underwent formal mesenteric LN dissection and prophylactic para-aortic LN dissection. Among 60 patients who underwent colorectal surgery with prophylactic para-aortic LN dissection, 21 cases (35%) were in the descending colon, 22 cases (36.7%) were in the sigmoid colon, 11 cases (18.3%) were in the recto-sigmoid, and 6 cases (10%) were in the upper rectum. 55 cases (91.7%) were in grade 2, and 5 cases (8.3%) were in grade 3. Neoadjuvant CTH was given in 3 cases (5%) while neoadjuvant RTH was given in 6 cases (10%). Regarding reported postoperative complications, lymphorrhea was reported in 2 patients (3.3%) and wound infection occurred in 6 patients (10%). A recurrence was reported among 8 cases (13.4%). We aimed in this study to highlight the value of prophylactic para-aortic lymph node dissection among colorectal cancer patients (over-treatment protocol) and report its reflection on predicting the behavior of the disease and subsequently selecting the patients who will be suitable to do this procedure.

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结肠直肠癌预防性主动脉旁淋巴结清扫术；试点研究

大肠癌是全球第三大常见癌症，占所有癌症类型的 10%，被认为是癌症相关死亡的第二大原因。它通常会转移到肝脏或肺部。根据 AJCC 标准，主动脉旁淋巴结转移属于转移性疾病（4 期），而根据 JSCCR 标准，则属于区域性疾病（3 期）。主动脉旁淋巴结转移发生率约为 1%。对于结直肠癌患者的主动脉旁淋巴结转移，新辅助 CTH 和 PALN 是最佳选择。本研究探讨了结肠直肠癌患者预防性主动脉旁 LN 切除术（过度治疗方案）的价值。这是一项前瞻性研究，纳入了 2020 年 12 月至 2023 年 12 月期间在开罗大学 NCI 就诊的患者，这些患者主诉左侧结肠癌或直肠乙状结肠癌，并接受了左半结肠切除术、乙状结肠切除术或 LAR。所有患者都接受了正规的肠系膜 LN 切除术和预防性主动脉旁 LN 切除术。在接受结直肠手术并预防性主动脉旁 LN 夹层的 60 例患者中，21 例（35%）位于降结肠，22 例（36.7%）位于乙状结肠，11 例（18.3%）位于直肠-乙状结肠，6 例（10%）位于直肠上部。55例（91.7%）为2级，5例（8.3%）为3级。3例（5%）接受了新辅助CTH治疗，6例（10%）接受了新辅助RTH治疗。关于术后并发症，2 例患者（3.3%）出现淋巴结肿大，6 例患者（10%）出现伤口感染。有 8 例（13.4%）患者复发。本研究旨在强调结直肠癌患者主动脉旁淋巴结清扫术（过度治疗方案）的预防性价值，并报告其在预测病情发展以及随后选择适合进行该手术的患者方面的反映。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.