Extensive lymphadenectomy in colorectal cancer with isolated para-aortic lymph node metastasis below the level of renal vessels

Background and objectives: The effects of isolated metastatic node dissection in the para-aortic region have not been established in colorectal cancer (CRC). The authors undertook to evaluate the role of para-aortic lymph node (PALN) dissection in CRC with isolated PALN metastasis. Methods: Between January 1993 and March 2006, 24 patients underwent PALN dissection for isolated PALN metastasis from CRC. Patients with distant metastases other than to PALNs, or with nodal metastasis above the celiac axis were excluded. The control group was composed of 53 patients with isolated PALN metastasis below the level of the renal hilum that was not surgically removed. Results: Median disease-free interval after PALN dissection was 14 months. The postoperative complication rate was 27.8%, which was not significantly different from that of the control group. Median survivals in the PALN dissection and control groups were 64 (range, 17-111) and 33 (range, 24-42) months, respectively. The overall 5-year survival rate was 53.4% in the PALN dissection group, versus 12.0% in the control group (P=0.045). Conclusions: The findings of this study suggest that PALN dissection increases the survival of patients with isolated PALN metastasis from CRC, and that it has a tolerable morbidity rate.