Solitary Nodal Recurrence in the Dorsal Area of the Thoracic Aorta After a Curative Resection of Esophageal Cancer: Report of Two Cases

Although locoregional recurrence is often observed in the cervicothoracic area even after an esophagectomy with three-field lymph node dissection (3FL), recurrence in the mediastinal lymph nodes is relatively rare. We experienced two cases of solitary recurrence in a posterior mediastinal node (No 112-ao) after a curative resection for thoracic esophageal cancer. The lymph node recurrence was located in the connective tissue adjacent to the left posterior wall of the thoracic aorta, and thus could not have been removed by the conventional approach of an esophagectomy through a right thoracotomy. These two patients underwent surgical removal of the tumor through left thoracotomy, and survived for 5 years and 1 year without recurrence, respectively. Because the rate of metastasis in this area appears to be low, it is not always necessary to perform complete nodal dissection of the left side of the descending aorta at the initial surgery in cases of thoracic esophageal cancer. However, our experience suggests the importance of periodic computed tomography scans to check for any nodal recurrence in this area, since a surgical resection may be effective when the recurrence is detected as a solitary metastasis.     

Metachronous mediastinal lymph node metastasis from ascending colon cancer: A case report and literature review

IntroductionMetachronous mediastinal lymph node metastasis without pulmonary metastasis is extremely rare in colorectal cancer, which makes the clinical diagnosis difficult and treatment strategy unclear.Prsentation of caseA case was a 59-year-old man, who had undergone right hemicolectomy for ascending colon cancer 2 years and 8 months previously, presented with enlarged mediastinal lymph nodes. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography revealed FDG was accumulated only into the mediastinal lymph nodes. Serum carcinoembryonic antigen (CEA) level was within the normal range. Six months later, the size and FDG uptake of the mediastinal lymph nodes had increased. We assumed a possibility that the mediastinal lymph nodes were metastasized from ascending colon cancer and so performed thoracoscopic-assisted resection of the mediastinal lymph nodes. Histopathological analysis revealed the resected lymph nodes were filled with moderately differentiated adenocarcinoma and a diagnosis of mediastinal lymph nodes metastasis from previously-resected ascending colon cancer was made. The patient was postoperatively followed for more than 1 year and 8 months without any sign of recurrence.DiscussionOnly 7 cases of metachronous mediastinal lymph node metastasis from colorectal cancer, including our case, have been reported in the English literature. It is difficult to clinically diagnose mediastinal lymph node metastasis.ConclusionWe report a rare case of metachronous mediastinal lymph node metastasis from ascending colon cancer with literature review. If the mediastinal lymph nodes are enlarged after colorectal cancer resection, we need to make a treatment strategy as well as a diagnostic approach considering the possibility of mediastinal lymph node metastasis.     

Curatively resected isolated inguinal lymph node metastasis from cecum cancer: report of a case

We herein report the case of a curatively resected solitary inguinal lymph node metastasis from cecum cancer. Our patient was a 67-year-old male with cecum cancer with abdominal wall invasion. Three years after surgery, inguinal lymph node swelling was detected by a computed tomography examination. Further examination revealed no other metastases. Surgical resection was performed to remove the lesion, and microscopic examination revealed that cancer cells had metastasized. No recurrence was detected 3 years after the salvage surgery. Inguinal lymph node metastasis of cecum cancer has not been reported in the literature, but in our case salvage surgery resulted in a good outcome.     

Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings

The autopsy findings of patients who died of recurrence after curative resection of pancreatic cancer may afford a reliable guide to increase long-term survival after surgery. Recurrence patterns were analyzed for 27 autopsied patients who had undergone potentially curative resection of pancreatic cancer. The pattern of recurrence was classified as follows: (1) local recurrence, (2) hepatic metastasis, (3) peritoneal dissemination, (4) para-aortic lymph node metastasis, and (5) distant metastasis not including hepatic metastasis, peritoneal dissemination, and para-aortic lymph node metastasis. Of the 27 autopsied patients, recurrence was confirmed for 22 of 24 patients, except for three who died of early postoperative complications. Eighteen (75%) of the 24 patients had local recurrence, 12 (50%) had hepatic metastasis, and 11 (46%) had both. For four patients, local recurrence confirmed by autopsy was undetectable by computed tomography, because the recurrent lesions had infiltrated without forming a tumor mass. Peritoneal dissemination, para-aortic lymph node metastasis, and distant metastasis were found for eight (33%), five (21%), and 18 (75%) of the cases, respectively. Twenty patients died of cancer, but local recurrence was judged to be the direct cause of death of only four. Local recurrence frequently occurs, but is rarely a direct cause of death, and most patients died of metastatic disease. Therefore, treatment that focuses on local control cannot improve the survival of patients with resectable pancreatic cancer, and thus, treatment regimens that are effective against systemic metastasis are needed.     

Surgery for intrathoracic recurrence of non-small cell lung cancer

In this study, we defined a solitary lung nodle in the same histology which could be traced its' origin from carcinoma in situ or was found over than two years' follow up as a second primary lung cancer. These cases were excluded. Eighteen cases underwent second surgery for intrathoracic recurrence. Fourteen cases were male and four cases were female. Their ages ranged from 23 to 75 (average 59.6) years. The histology were adenocarcinoma in 9 cases, squamouscarcinoma in 7, adenosquamous carcinoma in 1, large cell carcinoma in 1. The initial surgical procedures were lobectomy in 17, partial resection in 1. The initial stage were I in 13, II in 2, IIIA in 1. Pulmonary recurrence were found in 10, bronchial stump recurrence were found in 4, pulmonary hilus lymph node recurrence were found in 2, mediastinal lymph node recurrence were found in 2, pulmonary stump recurrence was found in 1. The second surgical procedures were completion pneumonectomy in 7, completion lobectomy in 1, lobectomy with segmentectomy in 1, segmentectomy or partial resection in 7, mediastinal dissection in 2. The overall 5-year survival rate of the patients with recurrence after reoperation was 31.8%. An aggressive surgical approach for recurrent lung cancer should be recommended.     

Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection

BACKGROUND: Radical lymph node dissection in surgery for advanced gallbladder cancer is controversial. The purpose of this study is to evaluate the role of lymph node dissection based on the clinico-pathologic results. PATIENTS: Seventy-three patients who underwent radical surgery including systematic dissection of the N1+N2 region lymph node plus some of the para-aortic nodes were reviewed. RESULTS: pT1 patients had no lymph node metastasis, but pT2 and pT3/pT4 patients had lymph node metastasis at a rate of 50.0% (13/26) and 83.3% (25/30), respectively. As infiltration of the hepatoduodenal ligament (Binf) became severe, the rate and extent of lymph node metastasis increased. There were four 5-year survivors with lymph node involvement. The 5-year survival rates are 77.0% in pN0 cases and 27.3% in pN1 cases (P<0.01). There was no difference in survival between pN1 and pN2 patients. However, significant differences in survival were observed between pN0/1 and pN2/3 patients when these patients were limited to Binf0/1. Examination of the recurrence pattern showed that most patients with pN0/1/2 had no regional lymph node recurrence, but there was para-aortic lymph node recurrence in patients with pN3 outside the dissected region. Significant prognostic factors influencing survival after surgery by multivariate analysis were pN2/3, pT, and residual tumor. CONCLUSION: Systematic lymph node dissection of N1, N2, and part of the para-aortic region improves survival in advanced gallbladder cancer patients, especially in those without either para-aortic lymph node metastases or Binf2/3.     

Outcome of surgical intervention for isolated intrathoracic lymph node metastasis from infradiaphragmatic malignancy: report of two cases.

We report 2 cases with isolated intrathoracic lymph node involvement. This is an unusual manifestation of metastatic spread from an extrathoracic malignancy. Case 1 was a 47-year-old female with a history of radical hysterectomy for cervical cancer of the uterus. Left intrathoracic lymphadenopathy was detected during follow-up. These lesions were surgically removed and diagnosed as multiple lymph node metastases. Two years later, right intrathoracic lymphadenopathy was evident and excised again. Eight months after the re-thoracotomy, retroperitoneal recurrence appeared and she died of the disease. Case 2 was a 41-year-old female with a history of resection of sigmoid colon cancer with liver metastases. A solitary nodule in the left upper lobe was shown by a chest computed tomography (CT). Left upper lobectomy was performed and the lesion was diagnosed as a solitary lymph node metastasis. She has had no recurrence for 3 years since thoracotomy.     

Resection of a posterior mediastinal metastasis of colon cancer

We report a resection of a posterior mediastinal metastasis of colon cancer. A 29-year-old man who had undergone a right hemicolectomy and liver resection for ascending colon cancer with liver metastasis was referred to our hospital with the diagnosis of a solitary posterior mediastinal metastasis. Tumor extirpation with descending aorta replacement was performed. Five months after the operation, local recurrence developed in the posterior mediastinum, which was also resected. He has been recurrence-free for 5 years since the second procedure. In this case, the metastases were believed to have occurred through the thoracic duct.     

Candidates for Curative Resection in Advanced Gastric Cancer Patients Who Had Equivocal Para-aortic Lymph Node Metastasis on Computed Tomographic Scan

Background The aim of this study was to determine how to select potential candidates for curative resection among advanced gastric patients with equivocal findings of para-aortic lymph node metastasis on computed tomography (CT).Methods We analyzed the clinicopathologic results of 23 advanced gastric cancer patients who were diagnosed as having equivocal findings of para-aortic lymph node metastasis on a CT scan and who underwent gastrectomy with D2 and para-aortic lymph node dissection.Results Twenty-two patients were male, and one patient was female. The median age of all study subjects was 52 years (range, 31–75 years). Sixteen underwent total gastrectomy, and seven underwent subtotal gastrectomy. The median number of A2 (suprarenal) lymph nodes harvested was 2 (range, 1–5), and that of B1 (infrarenal) lymph nodes was 6 (range, 1–17). Ten (43.5%) of the 23 patients were proven pathologically to have metastasis to para-aortic lymph nodes. Two patients with cT2 cancer had no metastatic para-aortic lymph node, whereas three patients with cT4 disease had metastatic para-aortic lymph nodes (P = .021). Seven (70.0%) of 10 patients with pathologic para-aortic lymph node metastasis experienced recurrence, whereas only 2 (15.4%) of 13 patients without experienced recurrence (P = .008). The Lauren classification was found to be an independent predictor of para-aortic lymph node metastasis (relative risk; .13; 95% confidence interval, .02–.83; P = .03).Conclusions More than half of gastric cancer patients with equivocal findings of para-aortic lymph node metastasis on CT are potential candidates for curative resection. The Lauren classification of gastric cancer in patients with equivocal CT findings of para-aortic lymph node metastasis would be helpful when deciding on clinical stage and treatment plans in these patients.     

Complete Response of Highly Advanced Colon Cancer with Multiple Lymph Node Metastases to Irinotecan Combined with UFT: Report of a Case

Massive lymph node metastasis of the para-aortic region and supraclavicular lymph nodes, Virchow's lymph node metastasis due to colon cancer, is extremely rare. We herein report a case of such systemic lymph node metastasis that was successfully treated with a combination of irinotecan (CPT-11) and UFT, a combination drug of tegafur and uracil. The patient was a 57-year-old woman who had a tumor in the ascending colon, and massively swollen para-aortic and supraclavicular lymph node metastasis. She was treated with combination chemotherapy of CPT-11 and UFT. The main tumor was detected as a decompressed scar, and the supraclavicular and para-aortic lymph nodes had completely disappeared after the second cycle of treatment. A histopathological examination and immunohistochemistry with cytokeratin showed complete remission of adenocarcinoma in the tumor and para-aortic lymph nodes. She remains alive without recurrence 52 months after chemotherapy. Combination chemotherapy of CPT-11 and UFT may be of potential value in the treatment of advanced colorectal carcinoma, and both histopathological and immunohistochemical confirmation of a complete remission may indicate prolonged disease-free survival.     

Improved treatment of thoracic esophageal cancer based on a retrospective study of recurrence following resection

Recurrence after resection of thoracic esophageal cancer was classified according to site of recurrence into 5 categories; 1) local recurrence, 2) recurrence at the anastomotic site, 3) recurrence in cervical or mediastinal lymph nodes, 4) recurrence in abdominal lymph nodes and 5) distant organ metastasis. Although the combined resection of the trachea or aorta was performed in several cases with local extension, its clinical results were not superior to those from palliative resection. To prevent recurrence at the anastomotic site, we performed either pharyngeal anastomosis with laryngectomy or esophageal anastomosis just below the larynx. However, such anastomosis just below the larynx was liable to cause aspiration pneumonia. To prevent lymph node recurrence in the neck or mediastinum, we performed cervical and mediastinal lymph node dissection. However, lymph node recurrence in the upper mediastinum of the left side was occasionally observed in case receiving this operation, with lymph node recurrence being decreased by postoperative irradiation, though prognosis was not always improved. Anti-cancer agents CDDP and VDS or 5Fu were effective. To prevent abdominal lymph node recurrence, we recommend that abdominal lymph node dissection is necessarily performed as for cardiac cancer. To prevent distant organ metastasis, we recommend anti-cancer therapy following radical lymph node dissection.     

Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of lymph node metastasis

The significance of resecting the head of the pancreas was clinicopathologically investigated, predominantly by examining the mode of lymph node metastasis, in patients with gallbladder cancer. Of 60 patients who underwent resection of gallbladder cancer, 24 patients (40.0%) had lymph node metastasis. The breakdown of lymph node metastases was as follows: 12b (24.0%), 16 (21.7%), 13 (17.1%), 8 (12.2%), 12c (12.0%), 12p (8.0%), and 6 (6.3%). Of 45 patients with advanced gallbladder cancer, 14 patients survived more than 5 years after surgery. In the absence of lymph node metastasis, there were some long-term survivors following D0 dissection, gallbladder resection, or liver bed resection. However, all five long-term survivors with lymph node metastasis underwent S4aS5 resection combined with pylorus preserving pancreatoduodenectomy (PPPD) and D3 dissection. Seven patients had number 13 lymph node metastasis, and only two n2 patients who underwent S4aS5 resection combined with PPPD and D3 dissection, survived more than 5 years. There were no long-term survivors with n3 lymph node metastasis. Of the 50 patients who underwent curative resection, 13 patients experienced recurrence: in the liver in six patients, in the peritoneum in four patients, in the lymph nodes in four patients, in the bone in two patients, in the lung in one patient, and local in one patient (including duplicate cases). Of the four patients with lymph node recurrence, two demonstrated number 12 and/or number 13 lymph node metastasis at the time of surgery and underwent bile duct-conserving D2 dissection, although cancer recurred in the head of the pancreas, probably due to recurrence in number 13 lymph node. Extensive resection including resection of the head of the pancreas was therefore effective in patients with up to n2 lymph node metastasis as long as the cancer could be completely sected.     

Distribution of recurrent lesions after radical resection of cancer of the thoracic esophagus

In 150 patients who got cancer recurrence after curative resection for cancer of the thoracic esophagus, the sites where recurrent lesions were clinically detected for the first time were examined. The distribution of recurrent lesions in patients who did not undergo neck dissection at the operation (group A) differed from the distribution in those who underwent neck dissection (group B). Cervical and/or upper mediastinal recurrence occurred in 49% of cases in group A and in 11% of group B. On the contrary, middle or lower mediastinal recurrence was more often in group B. The distribution of recurrent lesions varied depending on the state of lymph node metastasis detected at surgery. Cervical and upper mediastinal recurrence was much more frequent than hematogenic recurrence in cases without lymph node involvement in group A, while hematogenic recurrence was more frequent in cases with both mediastinal and abdominal lymph node metastasis. In the upper mediastinum, recurrence along the recurrent laryngeal nerves was most frequent and it was supposed to have developed from residual lymphatic metastases. In the middle and lower mediastinum, recurrent lesions were located around the left main bronchus and descending aorta, and cancer infiltration of the neighboring organs was frequent. Recurrence at the abdominal paraaortic nodes was observed mainly in cases with perigastric lymph node involvement.     

Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas-preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.     

直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究

目的探讨直径≤3cm的周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的情况,分析早期周围型NSCLC纵隔淋巴结转移的规律。方法 2000年1月1日～2008年12月31日治疗直径≤3cm的周围型NSCLC161例,男89例,女72例,年龄(63.4±10.7)岁,行肺叶切除或肺局限性切除加系统性纵隔淋巴结清扫术,分析其临床特征、病理特点及纵隔淋巴结转移规律。结果全组手术顺利,无死亡及严重并发症发生。肺叶切除153例,肺楔形切除7例,肺段切除1例。全组共清扫淋巴结2456枚,平均每例4.5±1.6组、13.1±7.3枚。术后病理:腺癌99例,鳞癌30例,肺泡细胞癌19例,其他类型肺癌13例。术后TNM分期:ⅠA期50例,ⅠB期62例,ⅡA期6例,ⅡB期10例,ⅢA期33例。N1组淋巴结转移率为23.6%(38/161),N2组转移率为20.5%(33/161),其中隆突下淋巴结转移率为8.1%(13/161),跳跃式纵隔转移率为6.8%(11/161),全组未发现下纵隔淋巴结转移。肺泡细胞癌及直径≤2cm的鳞癌、直径≤1cm的腺癌均无pN2转移。上肺癌发生pN2转移时上纵隔100%(19/19)受累,其中21.1%(4/19)同时伴有隆突下淋巴结转移;下肺癌则除主要转移至隆突下外(64.3%,9/14),还常直接单独转移至上纵隔(35.7%,5/14)。转移的纵隔淋巴结左肺癌主要分布在第5、6、7组,右肺癌主要分布在第3、4、7组。结论对于直径≤3cm的周围型NSCLC,肿瘤直径越大,其纵隔淋巴结转移率越高,肺泡细胞癌、直径≤2cm的鳞癌和≤1cm的腺癌其纵隔淋巴结转移率相对较低;上肺癌主要转移在上纵隔,下肺癌则隆突下及上纵隔均可转移;第5、6、7组淋巴结是左肺癌主要转移的位置,第3、4、7组是右肺癌主要转移的位置,术中应重点清扫。     

结肠癌根治术中淋巴结清扫及其对预后的影响

淋巴结转移是结肠癌细胞转移的主要途径之一,亦是导致结肠癌病人根治术后复发和死亡的重要原因。根治性手术在进展期结肠癌综合治疗中起着关键作用,淋巴结清扫是结肠癌根治性手术的关键环节,淋巴结清扫范围包括肠旁、中间和主淋巴结。每例结肠癌根治术后标本至少应剪取12枚淋巴结。结肠癌根治术中合理规范的淋巴结清扫与术后足够数量的淋巴结剪取是结肠癌精确分期的依据,对于指导制定辅助治疗方案和评估预后具有重要意义。     

Clinicopathological studies of the recurrence of esophageal squamous cell cancer--with special reference to the mode of recurrence and operative procedure

In 93 out of 201 patients (46%) with squamous cell carcinoma of the esophagus who underwent radical resection (excluding death within 30 days after operation), the site of recurrence could be identified by means of X-ray, CT, ultrasonography, and biopsy. Recurrence was found in 55% of 93 cases within 12 months after surgery and in 86% of 93 cases within 24 months. Of 93 patients with recurrences, lymph node recurrences were present in 44 cases, visceral recurrences in 32 cases, both lymph node and visceral recurrences in 11 cases and others in 6 cases. Neck and/or upper mediastinal lymph node recurrences were found in 10 out of 15 patients who had recurrences within 3 months after surgery. Careful examination should be made in the left recurrent nerve chain and extended lymph node resection of upper mediastinal region should be performed under the adequate indication. Esophageal squamous cell cancer has a tendency to recur in the lymph nodes initially, and visceral metastases may occur thereafter. The incidence of visceral recurrence increased remarkably, when neck and/or upper mediastinal lymph nodes were involved at the time of operation. Accordingly, both irradiation and chemotherapy should also be applied for improving the prognosis of esophageal carcinoma.     

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??Impact of lymph node dissection on prognosis in patients performed curative resection of colon cancer DAI Dong-qiu. Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang 110001, China
Abstract Lymph node metastasis is one of the main metastatic paths of colon cancer cells, also contributed to the major cause of recurrence and death in patients performed curative resection of colon cancer. Radical surgery may play a key role in comprehensive treatment of colon cancer, especially in advanced cases with lymph nodes metastasis. Systematic en bloc dissection of regional lymph nodes is a central aspect of colon cancer radical surgery, including paracolic/epicolic lymph nodes, intermediate lymph nodes along the artery and the main lymph nodes at the origin of the artery. A minimum of 12 lymph nodes should be retrieved in each colon cancer specimen. Accurate staging of colon cancer depends on rational standard lymph nodes dissection of radical operation and adequate lymph nodes harvesting of colon cancer specimen, which is important for determining prognosis and planning further treatment in patients performed curative resection of colon cancer.     

Metastatic renal cell carcinoma to the thyroid gland: report of seven cases and review of the literature

PURPOSE: The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. PATIENTS AND METHODS: Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. RESULTS: Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. CONCLUSIONS: Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.     

Lymph node metastasis from colon carcinoma at 11 years after the initial operation managed by lymph node resection and chemoradiation: A case report and a review of the literature

INTRODUCTIONLymph node metastasis from colorectal cancer after a disease-free interval (DFI) of >5 years is extremely rare, and occurs in <0.6% cases.PRESENTATION OF CASEA 60-year-old man underwent low anterior resection for sigmoid colon cancer. The lesion was an adenocarcinoma with no lymph node metastasis of Stage II. At 9 years after the colectomy, he was diagnosed with prostate cancer and was treated with radiation and hormonal therapies; at 11 years, he exhibited suddenly elevated carcinoembryonic antigen levels. Computed tomography (CT) and positron emission tomography-CT revealed a 2.0-cm para-aortic lymph nodes swelling invading the small intestine. These lymph nodes and the affected segment of the small intestine were resected, and histopathology of the resected specimen confirmed a metastatic tumor. The patient was administered radiation therapy after 22 cycles of 5-fluorouracil, oxaliplatin and leucovorin. He however presented with a residual lesion in the para-aortic lymph node, but currently, he has been symptom free for 4 years.DISCUSSIONA review of the literature indicates that the median survival of all previously reported patients is 12 months, and that colon cancer with a long DFI might be a slow growing. One of these patients and our patient both had received radiation and/or hormonal therapy for another cancer, which probably impaired their immune systems, thus resulting in metastatic tumors.CONCLUSIONWe report a case of lymph node metastasis after a DFI of >5 years and review relevant literature to assess the significance and possible reasons for delayed colorectal cancer metastases.