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Abstract：
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.
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.
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.
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.
Enlarged retroperitoneal lymph nodes on a pre-operative CT-scan should not automatically exclude patients from CRS-HIPEC.
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.
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.
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.
Enlarged retroperitoneal lymph nodes on a pre-operative CT-scan should not automatically exclude patients from CRS-HIPEC.
摘要：
探讨腹膜后淋巴结病(RPLP)在术前CT扫描对结直肠癌腹膜转移瘤(PM)细胞减灭术及腹腔热化疗(CRS-HIPEC)后总生存期(OS)和无病生存期(DFS)的影响。
在患有PM的腹膜后淋巴结肿大（RPLP）的患者中，通常被认为是区域外淋巴结转移，因此这些患者可能被排除在CRS-HIPEC之外。这是一个临床难题，因为通常很难从这些节点获得组织学。
在这个多中心，回顾性研究纳入2004年至2013年间接受CRS-HIPEC治疗的所有连续结直肠PM患者.根据肿大淋巴结的放射学外观，重新分析术前CT扫描是否存在RPLP。结果是OS和DFS。采用Kaplan-Meier法和Cox回归模型分析RPLP对OS和DFS的影响。
401例患者中有25例（6.1％）在术前CT扫描中观察到RPLP。病人,有和没有RPLP的组之间的肿瘤和手术特征无统计学差异.经过46个月的中位随访，Theone-,三年和五年生存率为80%,59%,38%和90%，50%,有和无RPLP组分别为36%。操作系统中位数（47vs.35个月,logrank：p=0.70）和平均DFS（14与15个月,logrank：p=0.81）两组之间没有统计学上的显着差异。在多变量分析中，RPLP对生存率无显著影响。
术前CT扫描扩大的腹膜后淋巴结不应自动排除CRS-HIPEC患者。
在患有PM的腹膜后淋巴结肿大（RPLP）的患者中，通常被认为是区域外淋巴结转移，因此这些患者可能被排除在CRS-HIPEC之外。这是一个临床难题，因为通常很难从这些节点获得组织学。
在这个多中心，回顾性研究纳入2004年至2013年间接受CRS-HIPEC治疗的所有连续结直肠PM患者.根据肿大淋巴结的放射学外观，重新分析术前CT扫描是否存在RPLP。结果是OS和DFS。采用Kaplan-Meier法和Cox回归模型分析RPLP对OS和DFS的影响。
401例患者中有25例（6.1％）在术前CT扫描中观察到RPLP。病人,有和没有RPLP的组之间的肿瘤和手术特征无统计学差异.经过46个月的中位随访，Theone-,三年和五年生存率为80%,59%,38%和90%，50%,有和无RPLP组分别为36%。操作系统中位数（47vs.35个月,logrank：p=0.70）和平均DFS（14与15个月,logrank：p=0.81）两组之间没有统计学上的显着差异。在多变量分析中，RPLP对生存率无显著影响。
术前CT扫描扩大的腹膜后淋巴结不应自动排除CRS-HIPEC患者。
