The impact of radiological retroperitoneal lymphadenopathy on survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases

L R van der Werf, E Wassenaar, A de Niet, F Lalezari, H J Braam, B van Ramshorst, J Nederend, I H J T de Hingh, N F M Kok, A G J Aalbers

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OBJECTIVES: 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.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: Enlarged retroperitoneal lymph nodes on a pre-operative CT-scan should not automatically exclude patients from CRS-HIPEC.

Original languageEnglish
Pages (from-to)376-382
Number of pages7
JournalEuropean Journal of Surgical Oncology
Issue number3
Publication statusPublished - Mar-2019
Externally publishedYes


  • Aged
  • Colorectal Neoplasms/mortality
  • Cytoreduction Surgical Procedures/methods
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced/methods
  • Lymph Nodes/diagnostic imaging
  • Lymphadenopathy/diagnosis
  • Male
  • Middle Aged
  • Netherlands/epidemiology
  • Peritoneal Neoplasms/diagnosis
  • Retrospective Studies
  • Survival Rate/trends
  • Time Factors
  • Tomography, X-Ray Computed/methods

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