Uehara Keisuke, Yamamoto Seiichiro, Fujita Shin, Akasu Takayuki, Moriya Yoshihiro
Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Dig Surg. 2007;24(5):375-81. doi: 10.1159/000107779. Epub 2007 Aug 4.
BACKGROUND/AIMS: This study investigated appropriate level of upward lymph node (LN) dissection in advanced lower rectal carcinoma.
A total of 285 consecutive patients with stage II/III lower rectal carcinoma were analyzed. LN dissection was classified as follows: division of the root of the superior rectal artery (UD2), division of the root of the inferior mesenteric artery (UD3) and UD3 with para-aortic LN dissection (UD4).
LN metastases at the root of the inferior mesenteric artery were found in 4 patients. Their prognoses were worse than those of the other stage III patients (p = 0.011). On the other hand, LN metastases along the superior rectal artery were discovered in 14 patients, whose 5-year overall survival rate was 61.2%. By removing the LNs either UD2 or UD3/4, a similar survival rate was achieved in stage III patients with LN metastases along the superior rectal artery.
Survival of a minority with metastatic LNs at the root of the inferior mesenteric artery was poor. Additionally, survival is no worse in patients with positive LN along the superior rectal artery as long as these positive nodes are resected by either UD2 or UD3/4. Low ligation is adequate for advanced lower rectal carcinoma.
背景/目的：本研究探讨了晚期低位直肠癌向上淋巴结清扫的合适范围。
对285例连续的II/III期低位直肠癌患者进行分析。淋巴结清扫分类如下：直肠上动脉根部清扫（UD2）、肠系膜下动脉根部清扫（UD3）以及肠系膜下动脉根部清扫联合腹主动脉旁淋巴结清扫（UD4）。
4例患者出现肠系膜下动脉根部淋巴结转移。他们的预后比其他III期患者更差（p = 0.011）。另一方面，14例患者发现沿直肠上动脉的淋巴结转移，其5年总生存率为61.2%。对于沿直肠上动脉有淋巴结转移的III期患者，通过行UD2或UD3/4清扫淋巴结，可获得相似的生存率。
肠系膜下动脉根部有转移淋巴结的少数患者预后较差。此外，只要沿直肠上动脉的阳性淋巴结通过UD2或UD3/4切除，其生存率并不更差。低位结扎对于晚期低位直肠癌是足够的。
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