Salani Ritu, Diaz-Montes Teresa, Giuntoli Robert L, Bristow Robert E
The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 N Wolfe St/Phipps 281, Baltimore, Maryland 21224, USA.
Ann Surg Oncol. 2007 Dec;14(12):3552-7. doi: 10.1245/s10434-007-9565-7. Epub 2007 Sep 25.
We sought to determine the incidence of mesenteric lymph node metastases in patients undergoing rectosigmoid resection for epithelial ovarian carcinoma and to evaluate the potential contribution of sigmoid mesocolectomy toward achieving complete surgical cytoreduction.
Pathology results for patients undergoing rectosigmoid colectomy for epithelial ovarian carcinoma from August 1998 through September 2005 were retrospectively reviewed. Fifty-three patients with pathological documentation of mesenteric lymph nodes were selected for further review. A focused analysis was performed on cases with an adequate surgical sampling of mesenteric lymph nodes (more than one positive or five total mesenteric lymph nodes) to determine the overall incidence of nodal metastases. Chi2 analysis was used to identify clinicopathologic factors associated with mesenteric lymphatic spread.
A total of 39 (73.6%) of 53 patients had an adequate mesenteric resection suitable for nodal analysis. In this subgroup, 32 (82.1%) of 39 patients had one or more mesenteric lymph nodes containing metastatic ovarian carcinoma. Invasion beyond the serosa of the rectosigmoid colon was present in 31 (79.5%) of 39 of cases; however, increasing depth of invasion was not associated with risk of mesenteric nodal disease. In addition to bowel wall involvement, the only clinical factor that correlated with mesenteric lymph node involvement was concurrent tumor spread to retroperitoneal lymph nodes (P = .025).
Locally advanced ovarian carcinoma involving the rectosigmoid colon is associated with a high incidence of mesenteric nodal metastasis. Standard surgical technique should include a sigmoid mesocolectomy with resection of the associated lymphatic tributaries at the time of rectosigmoid colectomy if the surgical objective is complete cytoreduction of occult nodal disease.
我们试图确定接受乙状结肠直肠切除术治疗上皮性卵巢癌患者的肠系膜淋巴结转移发生率，并评估乙状结肠系膜切除术对实现完全手术细胞减灭的潜在作用。
回顾性分析1998年8月至2005年9月期间接受乙状结肠直肠切除术治疗上皮性卵巢癌患者的病理结果。选择53例有肠系膜淋巴结病理记录的患者进行进一步分析。对肠系膜淋巴结手术取材充分（一个以上阳性或总共五个肠系膜淋巴结）的病例进行重点分析，以确定淋巴结转移的总体发生率。采用卡方分析确定与肠系膜淋巴扩散相关的临床病理因素。
53例患者中共有39例（73.6%）进行了适合淋巴结分析的充分肠系膜切除术。在该亚组中，39例患者中有32例（82.1%）有一个或多个肠系膜淋巴结含有转移性卵巢癌。39例病例中有31例（79.5%）存在乙状结肠直肠结肠浆膜外侵犯；然而，侵犯深度增加与肠系膜淋巴结疾病风险无关。除肠壁受累外，与肠系膜淋巴结受累相关的唯一临床因素是肿瘤同时扩散至腹膜后淋巴结（P = 0.025）。
累及乙状结肠直肠的局部晚期卵巢癌与肠系膜淋巴结转移的高发生率相关。如果手术目标是对隐匿性淋巴结疾病进行完全细胞减灭，标准手术技术应包括在乙状结肠直肠切除术时行乙状结肠系膜切除术并切除相关淋巴分支。
