Clin Colon Rectal Surg 2024; 37(02): 071-079
DOI: 10.1055/s-0043-1761474
Review Article

Management of Surgically Accessible Lymph Nodes Beyond Normal Resection Planes

Daniel deLahunta
1   Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
,
Surya Nalamati
1   Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
› Institutsangaben

Abstract

This article discusses the management of isolated metastatic lymph nodes for colon and rectal cancer. There are traditionally significant differences in how certain regions of lymph nodes for colon and rectal cancer are managed in the East and West. This has led to the development of the lateral lymph node dissection for rectal cancer and extended lymphadenectomy techniques for colon cancer. This article will evaluate the literature on these techniques and what the surgical and oncological outcomes are at this time. In addition, colon and rectal cancers can occasionally have isolated distant lymph node metastases. These would traditionally be treated as systemic disease with chemotherapy. There is consideration though that these could be treated as similar to isolated liver or lung metastases which have been shown to be able to be treated surgically with good oncological results. The literature for these isolated distant lymph node metastases will be reviewed and treatment options available will be discussed.



Publikationsverlauf

Artikel online veröffentlicht:
22. Februar 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Compton CC, Fielding LP, Burgart LJ. et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124 (07) 979-994
  • 2 Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005; 97 (03) 219-225
  • 3 Mahmoud N, Bullard Dunn K. Metastasectomy for stage IV colorectal cancer. Dis Colon Rectum 2010; 53 (07) 1080-1092
  • 4 Nelson H, Petrelli N, Carlin A. et al; National Cancer Institute Expert Panel. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001; 93 (08) 583-596
  • 5 McDonald JR, Renehan AG, O'Dwyer ST, Haboubi NY. Lymph node harvest in colon and rectal cancer: current considerations. World J Gastrointest Surg 2012; 4 (01) 9-19
  • 6 Benson AB, Venook AP, Al-Hawary MM. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19 (03) 329-359
  • 7 Norwood MG, Sutton AJ, West K, Sharpe DP, Hemingway D, Kelly MJ. Lymph node retrieval in colorectal cancer resection specimens: national standards are achievable, and low numbers are associated with reduced survival. Colorectal Dis 2010; 12 (04) 304-309
  • 8 Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003; 10 (01) 65-71
  • 9 Shiozawa M, Ueno H, Shiomi A. et al. Study protocol for an international prospective observational cohort study for optimal bowel resection extent and central radicality for colon cancer (T-REX study). Jpn J Clin Oncol 2021; 51 (01) 145-155
  • 10 Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 2009; 11 (04) 354-364 discussion 364–365
  • 11 Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon 2019; 3 (04) 175-195
  • 12 Kobayashi H, West NP. CME versus D3 dissection for colon cancer. Clin Colon Rectal Surg 2020; 33 (06) 344-348
  • 13 Kobayashi H, West NP, Takahashi K. et al. Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol 2014; 21 (suppl (Suppl. 03) S398-S404
  • 14 Karachun A, Panaiotti L, Chernikovskiy I. et al. Short-term outcomes of a multicentre randomized clinical trial comparing D2 versus D3 lymph node dissection for colonic cancer (COLD trial). Br J Surg 2020; 107 (05) 499-508
  • 15 Gouvas N, Agalianos C, Papaparaskeva K, Perrakis A, Hohenberger W, Xynos E. Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision. Int J Colorectal Dis 2016; 31 (09) 1577-1594
  • 16 Gao Z, Wang C, Cui Y. et al. Efficacy and safety of complete mesocolic excision in patients with colon cancer: three-year results from a prospective, nonrandomized, double-blind, controlled trial. Ann Surg 2020; 271 (03) 519-526
  • 17 Crane J, Hamed M, Borucki JP, El-Hadi A, Shaikh I, Stearns AT. Complete mesocolic excision versus conventional surgery for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2021; 23 (07) 1670-1686
  • 18 Numata M, Sawazaki S, Aoyama T. et al. D3 lymph node dissection reduces recurrence after primary resection for elderly patients with colon cancer. Int J Colorectal Dis 2019; 34 (04) 621-628
  • 19 Bertelsen CA, Neuenschwander AU, Jansen JE. et al. 5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol 2019; 20 (11) 1556-1565
  • 20 Olofsson F, Buchwald P, Elmståhl S, Syk I. No benefit of extended mesenteric resection with central vascular ligation in right-sided colon cancer. Colorectal Dis 2016; 18 (08) 773-778
  • 21 Olofsson F, Buchwald P, Elmståhl S, Syk I. High tie or not in resection for cancer in the sigmoid colon?. Scand J Surg 2019; 108 (03) 227-232
  • 22 Vogel JD, Felder SI, Bhama AR. et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum 2022; 65 (02) 148-177
  • 23 Hashiguchi Y, Muro K, Saito Y. et al; Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25 (01) 1-42
  • 24 Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?. Br J Surg 1982; 69 (10) 613-616
  • 25 Kanemitsu Y, Shida D, Tsukamoto S, Moritani K, Sakamoto R. Japanese evidences on nerve-preserving lateral pelvic lymph node dissection for rectal cancer: major historical milestones and clinical impact: the past, present and future. Clin Colon Rectal Surg 2020; 33 (06) 349-354
  • 26 Kusters M, Uehara K, Velde CJHV, Moriya Y. Is there any reason to still consider lateral lymph node dissection in rectal cancer? Rationale and technique. Clin Colon Rectal Surg 2017; 30 (05) 346-356
  • 27 Ogura A, van Oostendorp S, Kusters M. Neoadjuvant (chemo)radiotherapy and lateral node dissection: is it mutually exclusive?. Clin Colon Rectal Surg 2020; 33 (06) 355-360
  • 28 Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K. Japanese Society for Cancer of the Colon and Rectum. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease?. Ann Surg 2012; 255 (06) 1129-1134
  • 29 Kusters M, Beets GL, van de Velde CJ. et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg 2009; 249 (02) 229-235
  • 30 Emile SH, Elfeki H, Shalaby M, Sakr A, Kim NK. Outcome of lateral pelvic lymph node dissection with total mesorectal excision in treatment of rectal cancer: a systematic review and meta-analysis. Surgery 2021; 169 (05) 1005-1015
  • 31 Nagawa H, Muto T, Sunouchi K. et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 2001; 44 (09) 1274-1280
  • 32 Akiyoshi T, Ueno M, Matsueda K. et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol 2014; 21 (01) 189-196
  • 33 Ishihara S, Kawai K, Tanaka T. et al. Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy. Dis Colon Rectum 2017; 60 (05) 469-476
  • 34 Ogura A, Konishi T, Cunningham C. et al; Lateral Node Study Consortium. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol 2019; 37 (01) 33-43
  • 35 Yang X, Yang S, Hu T. et al. What is the role of lateral lymph node dissection in rectal cancer patients with clinically suspected lateral lymph node metastasis after preoperative chemoradiotherapy? A meta-analysis and systematic review. Cancer Med 2020; 9 (13) 4477-4489
  • 36 Kroon HM, Hoogervorst LA, Hanna-Rivero N. et al. Systematic review and meta-analysis of long-term oncological outcomes of lateral lymph node dissection for metastatic nodes after neoadjuvant chemoradiotherapy in rectal cancer. Eur J Surg Oncol 2022; 48 (07) 1475-1482
  • 37 Oh HK, Kang SB, Lee SM. et al. Neoadjuvant chemoradiotherapy affects the indications for lateral pelvic node dissection in mid/low rectal cancer with clinically suspected lateral node involvement: a multicenter retrospective cohort study. Ann Surg Oncol 2014; 21 (07) 2280-2287
  • 38 Kim HJ, Choi GS, Park JS. et al. Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer. Oncotarget 2017; 8 (59) 100724-100733
  • 39 Stewart CL, Warner S, Ito K. et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure?. Curr Probl Surg 2018; 55 (09) 330-379
  • 40 Zhao P, Yang X, Yan Y, Yang J, Li S, Du X. Effect of radical lymphadenectomy in colorectal cancer with para-aortic lymph node metastasis: a systematic review and meta-analysis. BMC Surg 2022; 22 (01) 181
  • 41 Gagnière J, Dupré A, Chabaud S, Peyrat P, Meeus P, Rivoire M. Retroperitoneal nodal metastases from colorectal cancer: curable metastases with radical retroperitoneal lymphadenectomy in selected patients. Eur J Surg Oncol 2015; 41 (06) 731-737
  • 42 Sasaki K, Nozawa H, Kawai K. et al. Management of isolated para-aortic lymph node recurrence of colorectal cancer. Surg Today 2020; 50 (09) 947-954
  • 43 Sahara K, Watanabe J, Ishibe A. et al. Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer. Int J Colorectal Dis 2019; 34 (06) 1121-1129
  • 44 Zizzo M, Dorma MPF, Zanelli M. et al. Long-term outcomes of surgical resection of pathologically confirmed isolated para-aortic lymph node metastases in colorectal cancer: a systematic review. Cancers (Basel) 2022; 14 (03) 661
  • 45 Grinnell RS. The lymphatic and venous spread of carcinoma of the rectum. Ann Surg 1942; 116 (02) 200-216
  • 46 Graham RA, Hohn DC. Management of inguinal lymph node metastases from adenocarcinoma of the rectum. Dis Colon Rectum 1990; 33 (03) 212-216
  • 47 Taylor N, Crane C, Skibber J. et al. Elective groin irradiation is not indicated for patients with adenocarcinoma of the rectum extending to the anal canal. Int J Radiat Oncol Biol Phys 2001; 51 (03) 741-747
  • 48 Yeo SG, Lim HW, Kim DY. et al. Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal?. Radiat Oncol 2014; 9: 296
  • 49 Shiratori H, Nozawa H, Kawai K. et al. Risk factors and therapeutic significance of inguinal lymph node metastasis in advanced lower rectal cancer. Int J Colorectal Dis 2020; 35 (04) 655-664
  • 50 Wang R, Wu P, Shi D. et al. Risk factors of synchronous inguinal lymph nodes metastasis for lower rectal cancer involving the anal canal. PLoS One 2014; 9 (11) e111770
  • 51 Tocchi A, Lepre L, Costa G. et al. Rectal cancer and inguinal metastases: prognostic role and therapeutic indications. Dis Colon Rectum 1999; 42 (11) 1464-1466
  • 52 Hagemans JAW, Rothbarth J, van Bogerijen GHW. et al. Treatment of inguinal lymph node metastases in patients with rectal adenocarcinoma. Ann Surg Oncol 2019; 26 (04) 1134-1141
  • 53 Tanabe T, Shida D, Komukai S, Nakamura Y, Tsukamoto S, Kanemitsu Y. Long-term outcomes after surgical dissection of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma. BMC Cancer 2019; 19 (01) 733
  • 54 Sato H, Maeda K, Kinugasa Y. et al. Management of inguinal lymph node metastases from rectal and anal canal adenocarcinoma. Colorectal Dis 2022; 24 (10) 1150-1163
  • 55 Chen M, Liu S, Xu M, Yi HC, Liu Y, He F. Radiation boost for synchronous solitary inguinal lymph node metastasis during neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Discov Oncol 2021; 12 (01) 59
  • 56 Alzahrani AM, Alshehri A. Synchronous colon adenocarcinoma with right inguinal lymph node metastasis: a case report and brief literature review. Cureus 2020; 12 (11) e11501
  • 57 Kitano Y, Kuramoto M, Masuda T. et al. Ascending colon cancer with synchronous external iliac and inguinal lymph node metastases but without regional lymph node metastasis: a case report and brief literature review. Surg Case Rep 2017; 3 (01) 32
  • 58 Iwata Y, Matsuhashi N, Takahashi T. et al. Ascending colon cancer with synchronous right external iliac lymph node metastasis. Int Cancer Conf J 2020; 9 (03) 162-167
  • 59 Hakeem A, Khan M, Dugar N, Muzaffar M, Robinson J. Inguinal lymphadenopathy secondary to adenocarcinoma of caecum: a case report. Open Med 2009; 4 (01) 131-133
  • 60 Wu YY, Xing CG, Jiang JX, Lu XD, Feng YZ, Wu HR. Carcinoma of the right side colon accompanied by Sister Mary Joseph's nodule and inguinal nodal metastases: a case report and literature review. Chin J Cancer 2010; 29 (02) 239-241
  • 61 Tanabe T, Shida D, Tsukamoto S, Morizono G, Taniguchi H, Kanemitsu Y. Metachronous metastasis to inguinal lymph nodes from sigmoid colon adenocarcinoma with abdominal wall metastasis: a case report. BMC Cancer 2019; 19 (01) 180
  • 62 Pisanu A, Deplano D, Reccia I, Parodo G, Uccheddu A. Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon. World J Surg Oncol 2011; 9: 128
  • 63 Uehara M, Yamamoto S, Fujita S, Akasu T, Moriya Y, Morisue A. Isolated right external iliac lymph node recurrence from a primary cecum carcinoma: report of a case. Jpn J Clin Oncol 2007; 37 (03) 230-232
  • 64 Terada I, Terai S, Watanabe T. et al. A case of ascending colon cancer with extra iliac lymph node metastases [in Japanese]. Gan To Kagaku Ryoho 2015; 42 (12) 2115-2117
  • 65 Hara M, Takahashi H, Sato M, Takayama S, Nagasaki T, Takeyama H. Curatively resected isolated inguinal lymph node metastasis from cecum cancer: report of a case. Surg Today 2013; 43 (01) 88-90
  • 66 Iwamoto M, Kawada K, Hida K, Hasegawa S, Sakai Y. Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case. Jpn J Clin Oncol 2015; 45 (02) 217-220
  • 67 Xie TH, Su P, Hong JG, Zhang H. Cervical lymph node enlargement as the initial manifestation of rectal cancer. BMC Gastroenterol 2021; 21 (01) 57
  • 68 Maslov D, Bragg J. Left cervical lymphadenopathy presentation of metastatic colorectal adenocarcinoma. Ochsner J 2019; 19 (04) 410-412
  • 69 Yang JQ, Shang L, Li LP. et al. Isolated synchronous Virchow lymph node metastasis of sigmoid cancer: a case report. World J Clin Cases 2021; 9 (32) 9917-9925
  • 70 Aksel B, Doğan L, Karaman N, Demirci S. Cervical lymphadenopathy as the first presentation of sigmoid colon cancer. Middle East J Cancer 2013; 4: 185-188
  • 71 Suliman MS, Singh M, Ajmeri AN, Stuart DL, Teka ST. Virchow's node: a case report of an extremely rare presentation of metastasis of adenocarcinoma with mucinous features from the colon. Int J Gen Med 2019; 12: 137-140
  • 72 Kurebayashi H, Goi T, Morikawa M. et al. Long-term survival in a patient with Virchow's lymph node metastasis of cecal cancer. Int Cancer Conf J 2017; 7 (01) 1-5
  • 73 Ohchi T, Akagi Y, Kinugasa T. et al. Virchow lymph node metastatic recurrence of sigmoid colon cancer with severe lymph node metastases successfully treated using systemic chemotherapy combined with radiotherapy. Anticancer Res 2013; 33 (07) 2935-2940
  • 74 Imamura H, Iino S, Sakamoto A. et al. 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 [in Japanese]. Gan To Kagaku Ryoho 2013; 40 (09) 1233-1236
  • 75 Min Kim H, Hasegawa J, Hirota M. et al. A case of sigmoid colon cancer with Virchow's lymph node metastasis successfully treated with chemotherapy [in Japanese]. Gan To Kagaku Ryoho 2012; 39 (12) 2249-2251