Significance of lymph node metastasis in patients with colorectal cancer peritoneal carcinomatosis.
BACKGROUND
Lymph node metastasis is common in patients with colorectal cancer. Its significance in patients at the time of primary colorectal surgery and later in patients who develop colorectal cancer peritoneal carcinomatosis (CRPC) is unknown. Lymphatic metastasis reflects a systemic spread of cancer and its implication on patients who undergo cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) for carcinomatosis needs to be studied.


METHODS
Patients with CRPC underwent CRS and PIC according to a standardized treatment protocol in our institution. Pathology reports from the primary colorectal surgery and at the time of treatment for CRPC was retrospectively retrieved and appraised. Comparison of survival outcomes using the log-rank test was performed for patients with and without lymphatic metastasis.


RESULTS
Sixty patients were treated for CRPC with CRS and PIC. At the time of colorectal surgery, patients with lymph node involvement had similar survival outcomes compared with patients without lymph node involvement (median survival: 31 months, 36 months; p = 0.9). However, when they subsequently develop peritoneal carcinomatosis and underwent treatment with CRS and PIC, patients with lymph node involvement did significantly worse (median survival: 20 months, 38 months; p = 0.003).


CONCLUSIONS
The results of our study suggest that lymph node metastasis in patients with CRPC is an indicator of a poor prognosis and requires further investigation and recognition.
Department of Surgery, University of New South Wales, St George Hospital, Kogarah, Sydney, NSW, Australia. terence.chua@student.unsw.edu.au
Terence C
TC
Chua
Tristan D
TD
Yan
Keh M
KM
Ng
Jing
J
Zhao
David L
DL
Morris
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis