title: [A case of rectal cancer which showed complete response to chemotherapy for para-aortic lymph node metastases remaining after surgery, for which resection of Virchow's lymph node recurrence led to long-term survival].
abstract: A 55-year-old man with a positive fecal occult blood test visited our department, and after a thorough medical evaluation, was diagnosed with Stage IV Rs rectal cancer with marked para-aortic lymph node metastasis. In December 2007, the patient underwent low anterior rectal resection with D3 lymph node dissection, but the para-aortic lymph nodes were left. The metastatic lymph nodes showed a complete response(CR)to post-operative chemotherapy with FOLFOX, FOLFIRI, IRIS, and irinotecan+cetuximab, and the complete response was sustained for 18 months after surgery. Later, he developed Virchow's lymph node metastasis, which was also resected. At present, 5 years after the first surgery, the patient, whose chemotherapy has been discontinued, is alive without recurrence. It appears that using key drugs, such as 5-fluorouracil, leukovorin, oxaliplatin, irinotecan, and cetuximab, and performing aggressive salvage surgery for Virchow's lymph node recurrence, led to long-term recurrence-free survival.
authors.affiliation: Dept. of Surgery, Akune Citizen Hospital, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iino
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Taisaku
authors.initials: T
authors.lastname: Kuwahata
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yonemori
authors.forename: Shun
authors.initials: S
authors.lastname: Onishi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Higashi
authors.forename: Hironori
authors.initials: H
authors.lastname: Sakita
authors.forename: Gen
authors.initials: G
authors.lastname: Tanabe
authors.forename: Shouji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001011:Aorta / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D013997:Time Factors