Lumboaortic and iliac lymphadenectomy for lymph node recurrence of colorectal cancer: prognostic value of the MSI phenotype

Abstract BACKGROUND: Some patients have isolated lumboaortic and/or iliac lymph node recurrences (ILNR) of colorectal cancer. Current guidelines recommend the use of chemotherapy. The aim of our study was to assess the carcinological results of lymphadenectomy for ILNR and to identify prognostic factors that may be used to select patients for this aggressive surgical approach. METHODS: Medical notes, pathological findings, and surgical procedure of patients who underwent lymphadenectomy for ILNR of colorectal cancer between 1998 and 2005 were reviewed. RESULTS: Ten patients (four women) underwent lymphadenectomy for ILNR. Lymphadenectomy was performed after a mean of 37 +/- 16.6 months after colon or rectal resection. Two patients developed a postoperative complication. Mean number of lymph nodes removed was 5.7 +/- 3.3. After a median follow-up of 30.7 months, four patients were alive, including two patients without recurrence at 95 and 96 months after colectomy and two with local and distant recurrences at 114 and 70 months. Among the three patients with microsatellite-unstable (MSI) tumors, two were free of disease at 61 and 81 months, respectively, and one died of recurrent disease 20 months after lymphadenectomy. CONCLUSION: Lymphadenectomy for ILNR of colorectal cancer is a feasible therapeutic option for selected patients. These preliminary results suggest that resection should be proposed for MSI patients because cure is possible, but to be confirmed, the findings require larger studies.