Significance of lymph node metastasis in patients with colorectal cancer peritoneal carcinomatosis.

BACKGROUND: Lymph node metastasis is common in patients with colorectal cancer. Its significance in patients at the time of primary colorectal surgery and later in patients who develop colorectal cancer peritoneal carcinomatosis (CRPC) is unknown. Lymphatic metastasis reflects a systemic spread of cancer and its implication on patients who undergo cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) for carcinomatosis needs to be studied.

METHODS: Patients with CRPC underwent CRS and PIC according to a standardized treatment protocol in our institution. Pathology reports from the primary colorectal surgery and at the time of treatment for CRPC was retrospectively retrieved and appraised. Comparison of survival outcomes using the log-rank test was performed for patients with and without lymphatic metastasis.

RESULTS: Sixty patients were treated for CRPC with CRS and PIC. At the time of colorectal surgery, patients with lymph node involvement had similar survival outcomes compared with patients without lymph node involvement (median survival: 31 months, 36 months; p = 0.9). However, when they subsequently develop peritoneal carcinomatosis and underwent treatment with CRS and PIC, patients with lymph node involvement did significantly worse (median survival: 20 months, 38 months; p = 0.003).

CONCLUSIONS: The results of our study suggest that lymph node metastasis in patients with CRPC is an indicator of a poor prognosis and requires further investigation and recognition.