Fazio Stefano, Ciferri Enrico, Giacchino Pietro, Municinò Olimpia, Rovida Salvatore, Bondanza Giuseppe Sergio, Gazzaniga Gian Massimo
Azienda Ospedale Galliera, U.O. Chirurgia, Università di Genova.
Chir Ital. 2002 Sep-Oct;54(5):649-57.
Of great interest today is the debate regarding the benefits and limitations of extended lymphadenectomy in rectal cancer, particularly with regard to patient survival. In the present report we review the experience of two different surgical departments: a total of 458 patients with rectal cancer were operated on in the 1st Surgical Department of S. Martino Hospital, Genoa, and in the 1st Surgical Department of Galliera Hospital, Genoa over the period from 1980 to 1989. Anterior rectal resection was performed in 137 rectal tumours at the S. Martino Hospital and in 146 at the Galliera Hospital. The mean follow-up was 48 months (range: 24-120 months). In the first group of patients, ligation at the origin of the mesenteric vessels (with subsequent peri-aortic lymphadenectomy) (D2-D3) was performed, while in the second group the mesenteric vessel ligation was done at the level of the origin of the left colic vessels (D1). There were no complementary therapies (radio or chemotherapy) either before or after surgery, because these were only introduced later. The data obtained from analysis of the long-term survival curves showed that there were no statistical differences between the two surgical experiences. The execution of extended lymphadenectomy would not appear to afford any additional benefit in terms of the survival of patients with rectal cancer. The well-matched starting conditions in the two groups allowed effective comparison between the two experiences and evaluation of the "pure" surgical aspect.
如今，关于直肠癌扩大淋巴结清扫术的益处和局限性，尤其是对患者生存率的影响，引发了激烈的争论。在本报告中，我们回顾了两个不同外科科室的经验：1980年至1989年期间，热那亚圣马蒂诺医院第一外科和热那亚加列拉医院第一外科共对458例直肠癌患者进行了手术。圣马蒂诺医院对137例直肠肿瘤患者进行了直肠前切除术，加列拉医院为146例。平均随访时间为48个月（范围：24 - 120个月）。在第一组患者中，在肠系膜血管起始处进行结扎（随后进行主动脉周围淋巴结清扫术）（D2 - D3），而在第二组中，肠系膜血管结扎在左结肠血管起始水平进行（D1）。手术前后均未进行辅助治疗（放疗或化疗），因为这些治疗后来才开始应用。对长期生存曲线分析得到的数据表明，两种手术经验之间没有统计学差异。就直肠癌患者的生存而言，扩大淋巴结清扫术似乎并未带来任何额外益处。两组良好匹配的起始条件使得能够对两种经验进行有效比较，并评估“纯粹”的手术方面。
