Long-term Survival With Mediastinal Nodal Metastasectomy in Colon Cancer

Abstract

INTRODUCTION: Metastectomy for colon cancer has been proven as a survival prolonging procedure for both liver and lung metastases. Data on metastectomy of the less common sites, retroperitoneum, mesentery and mediastinum, is minimal and thus has not become a widely adopted as a treatment strategy. We report long-term survival of a patient with a history of colon cancer who underwent a mediastinal metastectomy. CASE PRESENTATION: A 61 year-old male presented to our clinic with a mediastinal mass. Seven years prior to presentation, he underwent resection, which demonstrated T2N1 moderately differentiated mucinous adenocarcinoma. Postoperatively, he received six cycles of chemotherapy with 5-FU and leucovorin. Six years later, rising CEA levels prompted a PET scan which demonstrated isolated uptake in his abdomen. For this recurrence, he underwent resection of the abdominal mass and associated bowel. Pathology confirmed poorly differentiated infiltrating mucinous adenocarcinoma. Postoperatively, he underwent additional chemotherapy treatment with 5FU-leucovorin, Oxaliplatin and Avastin. One year later, CEA levels were again elevated. A PET scan revealed an isolated right paratracheal mass measuring 5.8 x 3.6 x 4.8 cm mass. He was taken to the operating room for muscle-sparing axillary thoracotomy with resection of the mediastinal mass and mediastinal lymphadenectomy. Pathology of the mass demonstrated multiple matted lymph nodes containing mucinous adenocarcinoma. However, seven lymph nodes were negative for malignancy. Postoperatively, he underwent adjuvant therapy and has remained disease free for five years. DISCUSSIONS: Over 50% of patients undergoing colon resection for colon adenocarcinoma will have metastases1. The most common site of metastasis is the liver, followed by the lungs. Metastectomy in isolated hepatic and pulmonary metastases has improved 5-year survival up to 40% or higher2. The morbidity and mortality of mediastinal lymphadenectomy has decreased over the past several years. Currently, patients can be discharged on the first postoperative day after minimally invasive techniques, such as a transcervical mediastinal lymphadenectomy. Given the minimal morbidity and mortality associated with this procedure, the potential role of mediastinal lymphadectomy in the management of patients with metastatic cancer should be investigated further. CONCLUSION: Progress in the diagnosis and treatment options allows cancer to be managed as a chronic disease. In patients with limited mediastinal disease, mediastinal lymphadectomy may afford a survival benefit. The procedure is associated with minimal morbidity and mortality. The oncologic and survival benefit of such a procedure should be evaluated.