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Abstract：
BACKGROUND: Para-aortic lymph node (PALN) metastases represent patterns of initial recurrence in only 2-6% CRC patients, after an estimated 23-28 month time interval. An increasing trend towards curative surgery has been witnessed in patients presenting with controlled PALN recurrence. Nevertheless, lack of consensus has impaired an unambiguous statement for PALN recurrence resection.
METHODS: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines, which led us to gain deeper insight into the prognostic factors and long-term outcomes after resection for synchronous or metachronous pathologically confirmed CRC isolated para-aortic lymph node metastases (PALNM). Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
RESULTS: The nine articles included covered a study period of 30 years (1988-2018), with a total of 161 patients. At presentation, most primary CRCs were located in the colon (74%) and 95.6%, 87.1% and 76.9% patients had T3-T4, N1-N2 and well/moderately differentiated CRC, respectively. We identified a 59.4-68% 3-year OS rate and 53.4-87.5% 5-year OS rate, with a 25-84 months median OS, 26.3-61% 3-year DFS rate and 0-60.5% 5-year DFS rate, with a 14-24 month median DFS. Overall, 62.1% re-recurrence rate ranged from 43.8% to 100%.
CONCLUSIONS: Although PALNMs resection in CRC patients may be considered a feasible and beneficial option, no conclusions or recommendations can be made taking into account the current evidence. Therefore, further randomized, possibly multicenter trials are strongly recommended and mandatory if we want to have our results confirmed and patient selection criteria clearly identified.
METHODS: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines, which led us to gain deeper insight into the prognostic factors and long-term outcomes after resection for synchronous or metachronous pathologically confirmed CRC isolated para-aortic lymph node metastases (PALNM). Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
RESULTS: The nine articles included covered a study period of 30 years (1988-2018), with a total of 161 patients. At presentation, most primary CRCs were located in the colon (74%) and 95.6%, 87.1% and 76.9% patients had T3-T4, N1-N2 and well/moderately differentiated CRC, respectively. We identified a 59.4-68% 3-year OS rate and 53.4-87.5% 5-year OS rate, with a 25-84 months median OS, 26.3-61% 3-year DFS rate and 0-60.5% 5-year DFS rate, with a 14-24 month median DFS. Overall, 62.1% re-recurrence rate ranged from 43.8% to 100%.
CONCLUSIONS: Although PALNMs resection in CRC patients may be considered a feasible and beneficial option, no conclusions or recommendations can be made taking into account the current evidence. Therefore, further randomized, possibly multicenter trials are strongly recommended and mandatory if we want to have our results confirmed and patient selection criteria clearly identified.
摘要：
背景：主动脉旁淋巴结（PALN）转移仅代表2-6％CRC患者的初始复发模式，经过估计的23-28个月的时间间隔。在PALN复发受到控制的患者中，已经看到了治愈性手术的增加趋势。然而，缺乏共识损害了PALN复发切除的明确陈述.
方法：我们遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了系统文献综述，这使我们更深入地了解同步或异时病理证实的CRC主动脉旁淋巴结转移（PALNM）切除后的预后因素和长期结局。Pubmed/MEDLINE,Embase,Scopus,Cochrane图书馆和WebofScience数据库用于搜索所有相关文献。
结果：包括的九篇文章涵盖了30年的研究时间（1988-2018年），共有161名患者。在介绍时,大多数原发性CRC位于结肠(74%)和95.6%，87.1％和76.9％的患者有T3-T4，N1-N2和高/中分化CRC，分别。我们确定了59.4-68%的3年OS率和53.4-87.5%的5年OS率，中位OS为25-84个月，26.3-61%3年DFS率和0-60.5%5年DFS率，14-24个月的平均DFS。总的来说,62.1%的再复发率为43.8%~100%。
结论：尽管在CRC患者中切除PALNMs可能被认为是一种可行且有益的选择，没有结论或建议可以考虑到目前的证据。因此,进一步随机化，如果我们希望确认我们的结果并明确确定患者选择标准,则强烈建议进行可能的多中心试验,并且是强制性的.
方法：我们遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了系统文献综述，这使我们更深入地了解同步或异时病理证实的CRC主动脉旁淋巴结转移（PALNM）切除后的预后因素和长期结局。Pubmed/MEDLINE,Embase,Scopus,Cochrane图书馆和WebofScience数据库用于搜索所有相关文献。
结果：包括的九篇文章涵盖了30年的研究时间（1988-2018年），共有161名患者。在介绍时,大多数原发性CRC位于结肠(74%)和95.6%，87.1％和76.9％的患者有T3-T4，N1-N2和高/中分化CRC，分别。我们确定了59.4-68%的3年OS率和53.4-87.5%的5年OS率，中位OS为25-84个月，26.3-61%3年DFS率和0-60.5%5年DFS率，14-24个月的平均DFS。总的来说,62.1%的再复发率为43.8%~100%。
结论：尽管在CRC患者中切除PALNMs可能被认为是一种可行且有益的选择，没有结论或建议可以考虑到目前的证据。因此,进一步随机化，如果我们希望确认我们的结果并明确确定患者选择标准,则强烈建议进行可能的多中心试验,并且是强制性的.
