Cutini G, Gesuelli G C, Sartelli M, Brianzoni E, Musolino G, Nestori M, Scibé R, Berbellini A
Department of General Surgery, Macerata Hospital, Via S. Lucia 2, 62100 Macerata, Italy.
Surg Endosc. 2001 Dec;15(12):1440-3. doi: 10.1007/s00464-001-0021-7.
Lymphadenectomy for rectal cancer, whether by open surgery or laparoscopy, is still a controversial subject. If we consider that approximately 20% of patients have nodal obturator metastases, then we must concede that extended lymphadenectomy is useless in the other 80% of patients. We set out to determine whether lymphoscintigraphy could show the lymphatic drainage from the cancer toward the obturator lymph nodes and thus help us to select the patients who would benefit by their removal. We also analyzed the possibility of applying the concept of the sentinel node to the treatment of rectal cancer.
Among 42 people who underwent laparoscopy for rectal cancer 11 patients with TNM stages T2-T3N0M0 were studied by CT & MRI, rectal ultrasonography, and lymphoscintigraphy with a colloidal injection of human albumin labeled with 99mTc at the base of the neoplasm. Afterward, the 11 patients underwent a lymphadenectomy that extended to the obturator nodes.
In two patients, lymphoscintigraphy showed lymphatic drainage toward the obturator nodes. In one case, there were metastases. Lymphoscintigraphy did not show lymphatic drainage toward the obturator nodes in any of the other patients, and there were no metastases among them. It was not possible to identify a sentinel node.
Lymphoscintigraphy can be used to select patients with rectal cancer who will be helped by a lymphadenectomy extended to the obturator nodes. However, the concept of the sentinel node cannot be applied to rectal cancer.
直肠癌的淋巴结清扫术，无论是通过开放手术还是腹腔镜手术，仍然是一个有争议的话题。如果我们认为大约20%的患者有闭孔淋巴结转移，那么我们必须承认，扩大淋巴结清扫术对其他80%的患者是无用的。我们着手确定淋巴闪烁造影是否能显示癌症向闭孔淋巴结的淋巴引流，从而帮助我们选择那些能从切除淋巴结中获益的患者。我们还分析了将前哨淋巴结概念应用于直肠癌治疗的可能性。
在42例行腹腔镜直肠癌手术的患者中，对11例TNM分期为T2 - T3N0M0的患者进行了CT、MRI、直肠超声检查以及在肿瘤基部注射99mTc标记的人白蛋白胶体进行淋巴闪烁造影检查。之后，这11例患者接受了扩大至闭孔淋巴结的淋巴结清扫术。
2例患者的淋巴闪烁造影显示有向闭孔淋巴结的淋巴引流。其中1例有转移。其他患者的淋巴闪烁造影均未显示向闭孔淋巴结的淋巴引流，且他们中无一例有转移。无法识别前哨淋巴结。
淋巴闪烁造影可用于选择那些能从扩大至闭孔淋巴结的淋巴结清扫术中获益的直肠癌患者。然而，前哨淋巴结概念不能应用于直肠癌。
