Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, Florida 3333, USA.
Dis Colon Rectum. 2009 Oct;52(10):1767-73. doi: 10.1007/DCR.0b013e3181b14eaf.
This study aimed to investigate the application of fat clearance in cases of rectal cancer after neoadjuvant chemoradiation.
All patients who underwent proctectomy (R0 resection) from 1998 to 2007 were included. N1 and N2 stages were regarded as N+ stage.
Two hundred thirty-seven patients were identified, including 157 patients in the neoadjuvant group and 80 patients in the nonneoadjuvant group. In both groups, patients were assigned to receive the traditional method of harvesting lymph nodes, or the fat clearance method. Before July 2001, the patients received the traditional method, and after July 2001, they received exclusively the fat clearance method. In the nonneoadjuvant group, there was no significant difference in the number of positive lymph nodes (0.5 +/- 0.2 vs. 1.0 +/- 0.3, P = 0.235), N stage (P = 0.265), or patients with N+ stage (7/31 vs. 16/49, P = 0.332) between the two methods, even though the total lymph node harvest was significantly increased by use of the fat clearance method (9.6 +/- 1.3 vs. 27.6 +/- 2.5, P < 0.001). In contrast, the total lymph node retrieval (5.2 +/- 0.6 vs. 20.4 +/- 1.2, P < 0.001), number of positive lymph nodes (0.4 +/- 0.2 vs. 1.2 +/- 0.3, P = 0.007), N stage (P = 0.005), and patients with N+ stage (6/51 vs. 34/106, P = 0.006) were all increased by fat clearance in the neoadjuvant group. Moreover, the number of patients with N+ stage was stratified by T stage level (T0-T4) to eliminate the background bias, and the results were confirmed.
The utilization of the fat clearance technique significantly influences lymph node staging in patients with rectal cancer following neoadjuvant chemoradiation. These findings suggest that fat clearance may represent a useful tool in all patients receiving neoadjuvant therapy; a more generalized application in colorectal carcinoma specimens remains controversial and warrants further investigation.
本研究旨在探讨新辅助放化疗后直肠癌脂肪清除在病例中的应用。
纳入 1998 年至 2007 年间接受直肠切除术（RO 切除）的所有患者。N1 和 N2 期被视为 N+期。
共确定 237 例患者，其中新辅助组 157 例，非新辅助组 80 例。两组患者均采用传统方法或脂肪清除法采集淋巴结。2001 年 7 月前，患者采用传统方法，2001 年 7 月后，仅采用脂肪清除法。非新辅助组中，两种方法之间阳性淋巴结数（0.5 +/- 0.2 与 1.0 +/- 0.3，P = 0.235）、N 期（P = 0.265）或 N+期患者比例（7/31 与 16/49，P = 0.332）均无显著差异，尽管脂肪清除法显著增加了总淋巴结采集量（9.6 +/- 1.3 与 27.6 +/- 2.5，P < 0.001）。相比之下，新辅助组中总淋巴结检索量（5.2 +/- 0.6 与 20.4 +/- 1.2，P < 0.001）、阳性淋巴结数（0.4 +/- 0.2 与 1.2 +/- 0.3，P = 0.007）、N 期（P = 0.005）和 N+期患者比例（6/51 与 34/106，P = 0.006）均通过脂肪清除增加。此外，通过 T 分期水平（T0-T4）对 N+期患者进行分层，以消除背景偏倚，结果得到证实。
在新辅助放化疗后直肠癌患者中，脂肪清除技术的应用显著影响淋巴结分期。这些发现表明，脂肪清除可能是所有接受新辅助治疗患者的有用工具；在结直肠癌标本中更广泛的应用仍存在争议，需要进一步研究。
