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      Surgical Roles in the Management of Metachronus Para-aortic Lymph Node Recurrence and Synchronous Para-aortic Lymph Node Metastasis in Colorectal Cancer Patients

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          Abstract

          ABSTRACT 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).

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          Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis.

          Shandra Bipat, Afina S Glas, Frederik J M Slors … (2004)
          To perform a meta-analysis to compare endoluminal ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging in rectal cancer staging. Relevant articles published between 1985 and 2002 were included if more than 20 patients were studied, histopathologic findings were the reference standard, and data were presented for 2 x 2 tables; articles were excluded if data were reported elsewhere in more detail. Two reviewers independently extracted data on study characteristics and results. Bivariate random-effects approach was used to obtain summary estimates of sensitivity and specificity for invasion of muscularis propria, perirectal tissue, and adjacent organs and for lymph node involvement. Summary receiver operating characteristic (ROC) curves were fitted for perirectal tissue invasion and lymph node involvement. Ninety articles fulfilled all inclusion criteria. For muscularis propria invasion, US and MR imaging had similar sensitivities; specificity of US (86% [95% confidence interval [CI]: 80, 90]) was significantly higher than that of MR imaging (69% [95% CI: 52, 82]) (P =.02). For perirectal tissue invasion, sensitivity of US (90% [95% CI: 88, 92]) was significantly higher than that of CT (79% [95% CI: 74, 84]) (P <.001) and MR imaging (82% [95% CI: 74, 87]) (P =.003); specificities were comparable. For adjacent organ invasion and lymph node involvement, estimates for US, CT, and MR imaging were comparable. Summary ROC curve for US of perirectal tissue invasion showed better diagnostic accuracy than that of CT and MR imaging. Summary ROC curves for lymph node involvement showed no differences in accuracy. For local invasion, endoluminal US was most accurate and can be helpful in screening patients for available therapeutic strategies. Copyright RSNA, 2004
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            Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis.

            Christopher Mann, Tracy-Louise Appleyard, Maurice H. J. Selman … (2008)
            Lymph node status is the key to determining the prognosis and treatment of cervical cancer. However, it cannot be assessed clinically, and testing for nodal metastasis is controversial. We sought to systematically review the diagnostic accuracy literature on sentinel node biopsy, positron emission tomography, magnetic resonance imaging and computed tomography to evaluate the accuracy of each index test in determining lymph node status in patients with cervical cancer. We searched MEDLINE (1966-2006), EMBASE (1980-2006), Medion (1980-2006) and the Cochrane library (Issue 2, 2006) for relevant articles. We also manually searched the reference lists from primary articles and reviews, and we contacted experts in the field for conference abstracts and unpublished studies. We performed random-effects meta-analysis of accuracy indices, and we performed meta-regression analysis to test the effect of study quality on diagnostic accuracy and to identify other sources of heterogeneity. We included 72 relevant primary studies, involving a total of 5042 women, in our analysis. We found that, in determining lymph node status, sentinel node biopsy had a pooled positive likelihood ratio of 40.8 (95% confidence interval [CI] 24.6-67.6) and a pooled negative likelihood ratio of 0.18 (95% CI 0.14-0.24). The pooled positive likelihood ratios (and 95% CI) were 15.3 (7.9-29.6) for positron emission tomography, 6.4 (4.9-8.3) for magnetic resonance imaging and 4.3 (3.0-6.2) for computed tomography. The pooled negative likelihood ratios (and 95% CIs) were 0.27 (0.11-0.66) for positron emission tomography, 0.50 (0.39-0.64) for magnetic resonance imaging and 0.58 (0.48-0.70) for computed tomography. Using a 27% pretest probability of lymph node metastasis among all cases (regardless of stage), we found that a positive sentinel node biopsy result increased post-test probability to 94% (95% CI 90%-96%), whereas a positive finding on positron emission tomography increased it to 85% (75%-92%). Sentinel node biopsy has greater accuracy in determining lymph node status among women with primary cervical cancer than current commonly used imaging methods.
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              Development and implementation of a synoptic MRI report for preoperative staging of rectal cancer on a population-based level.

              Robin S. McLeod, Mark Fruitman, Eisar Al-Sukhni … (2014)
              Colorectal cancer physician champions across the province of Ontario, Canada, reported significant concern about appropriate selection of patients for preoperative chemoradiotherapy because of perceived variation in the completeness and consistency of MRI reports.
              Article 0 comments Cited 18 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): jcol
                Title: Journal of Coloproctology (Rio de Janeiro)
                Abbreviated Title: J. Coloproctol. (Rio J.)
                Publisher: Sociedade Brasileira de Coloproctologia (Rio de Janeiro, RJ, Brazil )
                ISSN (Print): 2237-9363
                ISSN (Electronic): 2317-6423
                Publication date (Print and electronic): June 2022
                Volume: 42
                Issue: 2
                Pages: 131-139
                Affiliations
                [2] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of Anesthesia and Intensive Care Egypt
                [5] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of Pathology Egypt
                [4] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of Clinical Oncology and Nuclear Medicine Egypt
                [3] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of Medical Oncology Egypt
                [6] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of Internal Medicine Egypt
                [1] Zagazig Al Sharqia orgnameZagazig University orgdiv1Faculty of Medicine orgdiv2Department of General Surgery Egypt
                Article
                Publisher ID: S2237-93632022000200131 Publisher ID: S2237-9363(22)04200200131
                DOI: 10.1055/s-0042-1742310
                SO-VID: dbdf5754-52f3-4acb-91ca-3c8428029a73
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Date accepted : 25 October 2021
                Date received : 24 July 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 9
                Product

                SciELO Brazil

                Categories
                Subject: Original Articles

                Keywords: surgery,synchronous paraaortic lymph node metastasis,metachronous paraaortic lymph node recurrence,colorectal cancer
                Data availability:
                Keywords: surgery, synchronous paraaortic lymph node metastasis, metachronous paraaortic lymph node recurrence, colorectal cancer

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