Sugihara Kenichi, Kobayashi Hirotoshi, Kato Tomoyuki, Mori Takeo, Mochizuki Hidetaka, Kameoka Shingo, Shirouzu Kazuo, Muto Tetsuichiro
Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Dis Colon Rectum. 2006 Nov;49(11):1663-72. doi: 10.1007/s10350-006-0714-z.
This study was designed to clarify indication and benefit of pelvic sidewall dissection for rectal cancer.
The retrospective, multicenter study collected the data of rectal cancer patients who underwent surgery between 1991 and 1998 and were prospectively followed.
Of 1,977 patients with rectal cancers, 930 underwent pelvic sidewall dissection without adjuvant radiotherapy. Positive lateral lymph nodes were found in 129. Multivariate analysis disclosed a significantly increased incidence of positive lateral lymph nodes in female gender, lower rectal cancers, non-well-differentiated adenocarcinoma, tumor size of > or =4 cm and T3-T4. The five-year survival rate for 1,977 patients was 79.7 percent. The survival of patients with positive lateral lymph nodes was significantly worse than that of Stage III patients with negative lateral lymph nodes (45.8 vs. 71.2 percent, P<0.0001). Multivariate analysis showed significantly worse prognosis in male gender, pelvic sidewall dissection, lower rectal cancers, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes. During the median follow-up time of 57 months, recurrence developed in 19.7 percent: 17 percent in negative and 58.1 percent in positive lateral lymph nodes (P<0.0001). Local recurrence was found in 8 percent: 6.8 percent in negative and 25.6 percent in positive lateral lymph nodes (P<0.0001). Multivariate analysis disclosed that lower rectal cancers, non-well-differentiated adenocarcinoma, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes were significantly associated with an increased local recurrence.
Positive lateral lymph node was the strongest predictor in both survival and local recurrence. Pelvic sidewall dissection may be indicated for patients with T3-T4 lower rectal cancers because of the greater probability of positive lateral lymph nodes.
本研究旨在阐明直肠癌盆腔侧壁清扫术的适应证及益处。
这项回顾性多中心研究收集了1991年至1998年间接受手术且进行前瞻性随访的直肠癌患者的数据。
1977例直肠癌患者中，930例行盆腔侧壁清扫术，未接受辅助放疗。发现129例侧方淋巴结阳性。多因素分析显示，女性、低位直肠癌、低分化腺癌、肿瘤大小≥4 cm及T3 - T4期患者侧方淋巴结阳性发生率显著增加。1977例患者的五年生存率为79.7%。侧方淋巴结阳性患者的生存率明显低于侧方淋巴结阴性的Ⅲ期患者（45.8%对71.2%，P<0.0001）。多因素分析显示，男性、盆腔侧壁清扫术、低位直肠癌、T3 - T4期、直肠周围淋巴结转移及侧方淋巴结阳性患者预后明显较差。在中位随访时间57个月期间，19.7%出现复发：侧方淋巴结阴性者为17%，阳性者为58.1%（P<0.0001）。8%出现局部复发：侧方淋巴结阴性者为6.8%，阳性者为25.6%（P<0.0001）。多因素分析显示，低位直肠癌、低分化腺癌、T3 - T4期、直肠周围淋巴结转移及侧方淋巴结阳性与局部复发增加显著相关。
侧方淋巴结阳性是生存及局部复发的最强预测因素。由于侧方淋巴结阳性概率较高，盆腔侧壁清扫术可能适用于T3 - T4期低位直肠癌患者。
