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Para-aortic Lymph Node Dissection for Colorectal Cancer: Predicting Pathologic Lymph Node Positivity and Optimizing

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Para-aortic lymph node (PALN) metastasis in colorectal cancer patients undergoing dissection indicates poorer survival. Factors like metachronous disease and imaging findings predict positive pathology, guiding treatment decisions for better outcomes.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • Para-aortic lymph node (PALN) involvement in colorectal cancer signifies advanced disease.
  • Selecting patients for PALN dissection to maximize oncologic benefit is challenging.
  • This study aimed to identify predictors of survival in colorectal cancer patients undergoing PALN dissection.

Purpose of the Study:

  • To identify factors predicting survival in colorectal cancer patients undergoing PALN dissection.
  • To evaluate the impact of pathologically positive PALN on recurrence-free survival (RFS) and overall survival (OS).

Main Methods:

  • Retrospective analysis of 74 colorectal cancer patients who underwent curative-intent PALN dissection (2007-2020).
  • Comparison of patients with and without pathologically positive PALN.
  • Survival analysis to assess the impact of positive PALN on RFS and OS.

Main Results:

  • Of 74 patients, 28 (37.8%) had pathologically positive PALN.
  • Positive PALN pathology was associated with metachronous disease and abnormal imaging findings.
  • Pathologically positive PALN significantly decreased RFS (HR 3.90) and OS (HR 4.49).
  • Well/moderately differentiated histology and metachronous disease were associated with better OS in pathologically positive PALN cases.

Conclusions:

  • Pathologically positive PALN are linked to worse RFS and OS after dissection in colorectal cancer.
  • Clinicopathologic factors can predict PALN positivity.
  • Curative-intent surgery may benefit selected patients, particularly those with well/moderately differentiated tumors and possibly metachronous disease.