Yano H, Saito Y, Takeshita E, Miyake O, Ishizuka N
Division of Colorectal Surgery, International Medical Centre of Japan, Tokyo, Japan.
Br J Surg. 2007 Aug;94(8):1014-9. doi: 10.1002/bjs.5665.
The clinical significance of lateral pelvic lymphatic spread in rectal cancer remains unknown. The present study aimed to assess the accuracy of preoperative computed tomography (CT) for prediction of lateral node involvement in patients with low rectal cancer and to determine the prognostic significance of extended lateral node dissection.
A total of 109 patients with primary low rectal cancer were enrolled in this prospective cohort study. The preoperative CT findings were compared with the histopathological results and with follow-up data.
CT diagnosed lateral lymph node status with high accuracy (sensitivity 95 per cent, specificity 94 per cent), in marked contrast to mesorectal node status. Of 68 patients who had R0 resection without lateral node dissection, only two developed pelvic wall recurrence during median follow-up of 4.1 years. Metastatic nodes in the lateral pelvic region were significantly larger than those in the mesorectum (P < 0.001).
CT accurately predicted lateral lymph node status in low rectal cancer, allowing preoperative identification of patients who might benefit from extended lateral node dissection.
直肠癌中外侧盆腔淋巴结转移的临床意义尚不清楚。本研究旨在评估术前计算机断层扫描（CT）预测低位直肠癌患者外侧淋巴结受累情况的准确性，并确定扩大外侧淋巴结清扫术的预后意义。
本前瞻性队列研究共纳入109例原发性低位直肠癌患者。将术前CT检查结果与组织病理学结果及随访数据进行比较。
CT诊断外侧淋巴结状态的准确性较高（敏感性95%，特异性94%），这与直肠系膜淋巴结状态形成显著对比。在68例未进行外侧淋巴结清扫的R0切除患者中，中位随访4.1年期间只有2例发生盆腔壁复发。盆腔外侧区域的转移淋巴结明显大于直肠系膜内的转移淋巴结（P<0.001）。
CT能准确预测低位直肠癌的外侧淋巴结状态，有助于术前识别可能从扩大外侧淋巴结清扫术中获益的患者。
