Poller D N
Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY, UK.
Eur J Surg Oncol. 2000 Dec;26(8):758-62. doi: 10.1053/ejso.2000.0999.
There is now evidence that meticulous specimen dissection may 'upstage' around one-quarter of colorectal cancers from node negative to node positive, although there is much debate as to how to achieve this: some authors prefer fat clearance techniques while others have opted for more conventional lymph-node retrieval with manual specimen 'breadknifing' and lymph-node palpation. While fat clearance is probably the optimum technique, it is time-consuming, costly and does not provide rapid diagnostic results.
A prospective pathological study of 50 colorectal cancer resections was conducted with 100 comparison cases, the study group receiving at least an additional 24-h fixation of the mesocolonic or mesorectal fat in 10% aqueous formaldehyde prior to specimen dissection.
The percentage of node-negative colorectal cancer was significantly lower in the study group compared with the matched comparison group: (18) 36% compared with (55) 55% of comparison cases.
Effective lymph-node retrieval techniques require mesocolic/mesorectal fat to be adequately fixed prior to pathological dissection. This study suggests that satisfactory lymph-node retrieval is possible without fat clearance, provided the mesenteric fat is suitably fixed prior to colorectal cancer specimen dissection.
目前有证据表明，细致的标本解剖可能会使约四分之一的结直肠癌分期从淋巴结阴性提升至淋巴结阳性，尽管对于如何实现这一点存在诸多争议：一些作者倾向于脂肪清除技术，而另一些人则选择采用更传统的淋巴结清扫方法，即手动对标本进行“面包刀式”切割和淋巴结触诊。虽然脂肪清除可能是最佳技术，但它耗时、成本高且无法提供快速诊断结果。
对50例结直肠癌切除术进行前瞻性病理学研究，并设置100例对照病例，研究组在标本解剖前，将结肠系膜或直肠系膜脂肪在10%甲醛水溶液中额外固定至少24小时。
研究组中淋巴结阴性的结直肠癌百分比显著低于匹配的对照组：分别为18例（36%）和55例（55%）。
有效的淋巴结清扫技术要求在病理解剖前对结肠系膜/直肠系膜脂肪进行充分固定。本研究表明，在结直肠癌标本解剖前对肠系膜脂肪进行适当固定的情况下，不进行脂肪清除也可能实现满意的淋巴结清扫。
