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Eur J Surg Oncol. 2019 Mar;45(3):376-382. doi: 10.1016/j.ejso.2018.10.540. Epub 2018 Nov 1.

The impact of radiological retroperitoneal lymphadenopathy on survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases.

Author information

1
Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands. Electronic address: l.r.vdwerf@gmail.com.
2
Department of Surgical Oncology, Antonius Hospital, Nieuwegein, the Netherlands.
3
Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
4
Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
5
Department of Surgical Oncology, Catharina Hospital, Eindhoven, the Netherlands.
6
Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands.
7
Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands. Electronic address: a.aalbers@nki.nl.

Abstract

OBJECTIVES:

To investigate the impact of retroperitoneal lymphadenopathy (RPLP) on pre-operative CT scan on overall survival (OS) and disease-free survival (DFS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal metastases (PM) of colorectal cancer.

BACKGROUND:

In patients with PM enlarged retroperitoneal lymph nodes (RPLP) are usually considered extra-regional lymph node metastases and therefore these patients may be excluded from CRS-HIPEC. This is a clinical dilemma since it is often hard to obtain histology from these nodes.

METHODS:

In this multicenter, retrospective study all consecutive patients with colorectal PM treated with CRS-HIPEC between 2004 and 2013 were included. The preoperative CT-scan was re-analyzed for the presence of RPLP based on the radiological appearance of enlarged lymph nodes. Outcomes were OS and DFS. Kaplan-Meier methods and Cox regression modeling were used to analyze the impact of RPLP on OS and DFS.

RESULTS:

In 25 of 401 patients (6.1%) RPLP was observed on the preoperative CT-scan. Patient, tumor and surgical characteristics did not statistically significantly differ between groups with and without RPLP. After a median follow-up of 46 months, the one-, three- and five-year survival was 80%, 59%, 38% and 90%, 50%, 36% in the group with and without RPLP respectively. Median OS (47 vs. 35 months, logrank: p = 0.70) and median DFS (14 vs. 15 months, logrank: p = 0.81) did not statistically significantly differ between groups. In multivariable analysis, RPLP did not significantly influence survival.

CONCLUSION:

Enlarged retroperitoneal lymph nodes on a pre-operative CT-scan should not automatically exclude patients from CRS-HIPEC.

KEYWORDS:

CRS-HIPEC; Hipec; Retroperitoneal lymph nodes; Retroperitoneal lymphadenopathy; peritoneal metastases

PMID:
30414704
DOI:
10.1016/j.ejso.2018.10.540
[Indexed for MEDLINE]

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