Abdominal lymph node recurrence from colorectal cancer: Resection should be considered as a curative treatment in patients with controlled disease

Alban Zarzavadjian Le Bian (1, 2, 3) , Laurent Genser (2, 4, 5) , Nicolas Tabchouri (6) , Clari Fillol (7) , Anais Laforest (7) , Christophe Tresallet (2, 4) , Mehdi Ouaissi (6) , David Fuks (7, 8)

1 ETRES - Éthique, recherches, translations = Ethics, research, translations [CRC]
2 Hôpital Avicenne [AP-HP]
3 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
4 UP13 - Université Paris 13
5 Nutriomics - Nutrition et obésités: approches systémiques (UMR-S 1269)
6 Hôpital Trousseau
7 IMM - Institut Mutualiste de Montsouris
8 UPD5 - Université Paris Descartes - Paris 5

Background: Lymph node recurrences (LNR) from colorectal cancer (CRC) still represent a therapeutic challenge, as standardized recommendations have yet to be established. The aim of this study was to analyze short- and long-term oncological outcomes following resection of LNR from CRC. Methods: All patients with previously resected CRC who underwent histopathologically confirmed LNR resection in 3 tertiary referral centers between 2010 and 2017 were reviewed. Short- and long-term outcomes were analyzed, mainly recurrence-free and overall survival. Further recurrences following LNR resection were also analyzed. Results: Overall, 18 patients were included. Primary CRC was left-sided in 16 (89%) patients, staged T3-4 in 15 (83%), N+ in 14 (78%) and presented with synchronous metastases in 8 (43%). Median time interval between primary CRC and LNR resections was 31 months. Performed lymphadenectomies were aortocaval (n = 10), pelvic (n = 7), in hepatic pedicle (n = 3) and mesenteric (n = 1). Four patients had associated liver metastases resection. Three (17%) presented with postoperative complications, of which one Clavien-Dindo 3. Fourteen (78%) patients presented with further recurrences after a mean delay of 9 months, with 36% of patients presenting with early (<6 months) recurrence. Five (36%) patients could undergo secondary recurrence resection and 3 (21%) patients radiotherapy. Median overall survival following LNR resection reached 44 months. Conclusions: Current results suggest that LNR resection is feasible and associated with improved survival, in selected patients. Longer time interval between primary CRC resection and LNR occurrence appeared to be a favorable prognostic factor whereas multisite recurrence appeared to be associated with impaired long-term survival.

Mots clés: Lymph node recurrence; Lymphadenectomy; Colorectal cancer

Domaines: Sciences du Vivant [q-bio]

Alban Zarzavadjian Le Bian, Laurent Genser, Nicolas Tabchouri, Clari Fillol, Anais Laforest, et al.. Abdominal lymph node recurrence from colorectal cancer: Resection should be considered as a curative treatment in patients with controlled disease. Surgical Oncology, 2020, 35, pp.206 - 210. ⟨10.1016/j.suronc.2020.08.019⟩. ⟨hal-03491525⟩