title: Central retroperitoneal recurrences from colorectal cancer: are lymph node and locoregional recurrences the same disease?
abstract: BACKGROUND
  Central retroperitoneal recurrences (CRRs) from colorectal carcinoma carry a poor prognosis. A CRR is sometimes defined as a locoregional recurrence (LR) and sometimes as a lymph node recurrence (NR). This study was conducted to determine the nature of CRR and evaluate prognostic factors after complete CRR resection.
  
  
  METHODS
  Between January 1988 and December 2008, 31 patients underwent a complete resection of CRR. CRRs were divided into NR (n = 23) and LR (n = 8), whether pathological examination disclosed lymph node involvement or not.
  
  
  RESULTS
  No differences were found between LR and NR regarding TNM stage, primary tumour location, time interval from primary tumour resection to CRR, number of metastatic sites, number of metastatic lesions and therapeutic management. The median preoperative CEA level was higher in the NR group (p = 0.003). After a median follow-up of 47 months NRs were associated with better overall survival (OS) (p = 0.03). Three-year OS and disease-free survival (DFS) in the LR and NR groups were 27% and 0% versus 81% and 26%, respectively. Twenty-seven (87%) patients developed a re-recurrence within a median interval of 15 months. The number of metastatic sites or lesions, the size of the CRR, the type of chemotherapy, radiotherapy, the interval between the primary resection and CRR and the TNM stage had no impact on OS.
  
  
  CONCLUSIONS
  LR in patients with CRR had a poorer prognosis than NR. A multimodality approach with complete resection may yield long-term survival for NR.
authors.affiliation: Department of Digestive Oncological Surgery, Institut Gustave Roussy, Villejuif, France. Frederic.DUMONT@igr.fr
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: K
authors.initials: K
authors.lastname: Kothodinis
authors.forename: D
authors.initials: D
authors.lastname: Goéré
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.forename: P
authors.initials: P
authors.lastname: Dartigues
authors.forename: V
authors.initials: V
authors.lastname: Boige
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
authors.forename: D
authors.initials: D
authors.lastname: Malka
authors.forename: D
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen