Results of lymphadenectomy for obvious lateroaortic lymph node metastases from colorectal primaries

Background/Aims: To analyze the results of surgery for macroscopically or r adiologically obvious (i.e., easily detectable by computed tomography scan or by palpation) synchronous or metachronous lateroaortic lymph node metast ases from colorectal primaries. Methodology: Thirty-one highly selected patients who underwent a lateroaort ic lymphadenectomy for obvious lateroaortic lymph node metastases from Janu ary 1989 to January 1999 were analyzed retrospectively. An associated metas tatic lesion was present in 68% of the cases before or concomitantly with t he lateroaortic lymph node metastases. Ten lateroaortic lymph node metastas es were synchronous with the primary, and 21 were metachronous. Decision fo r lymphadenectomy was taken after a multidisciplinary meeting and a period of observation. Median follow-up after lymphadenectomy was 24.2 months (ran ge: 6-120). All the patients received at least two systemic lines of chemot herapy before or after the lateroaortic lymphadenectomy. Results: There was no postoperative mortality. Resection was macroscopicall y complete (RD-l of UICC) in 26 cases (84%). Twenty-six (83.8%) patients de veloped recurrent lesions or had progressive residual disease. The most fre quent first site of recurrence was intrathoracic (54.8%) for the entire ser ies, except for the subgroup of isolated lateroaortic lymph node metastases in which recurrent lesions were mainly lateroaortic. Three-year global and disease-free survival rates were, respectively, 39% and 9.6%. No significa nt difference was noted in survival between lateroaortic lymph node metasta ses that were synchronous or metachronous with the primary. However, the mo st important prognostic factor was the presence of associated metastases. I ndeed 3-year survival attained 30% when lateroaortic lymph node metastases were isolated but 0% when lateroaortic lymph node metastases were associate d with another metastatic site (P=0.006). Conclusions: Obvious lateroaortic lymph node metastasis is rarely isolated. However, when it is isolated, in selected cases (objective response to sys temic chemotherapy, good general status), resection can be beneficial whate ver its synchronous or metachronous appearance.