Colorectal Division, Aristides Maltez Cancer Hospital, Salvador, Bahia, Brazil.
Jpn J Clin Oncol. 2010 Aug;40(8):746-53. doi: 10.1093/jjco/hyq060. Epub 2010 May 10.
The good prognosis of retroperitoneal and lateral pelvic lymphadenectomy has raised the question of whether total mesorectal excision is suitable for adequate staging of rectal adenocarcinoma patients. The aims of this study were to determine the accuracy of dye and probe detection of metastatic retroperitoneal and/or lateral pelvic nodes and to define the upstaging impact of retroperitoneal and lateral pelvic lymphadenectomy in rectal adenocarcinoma patients.
Ninety-seven rectal adenocarcinoma patients were submitted to total mesorectal excision and retroperitoneal and lateral pelvic lymphadenectomy. Lymphoscintigraphy using technetium-99 m-phytate and patent blue was performed to detect blue and/or radioactive retroperitoneal and/or lateral pelvic nodes which were examined histopathologically and immunohistochemically with a step-sectioning technique.
Mesorectal mean node count was 11.5 and retroperitoneal and/or lateral pelvic node was 11.7. Retroperitoneal and lateral pelvic lymphadenectomy identified metastases in 17.5%, upstaging 8.2%. Variables related to metastatic retroperitoneal and/or lateral pelvic nodes were the following: Stage III in total mesorectal excision specimens (P < 0.04), pT3/pT4 tumors (P = 0.047), high levels of carcinoembryonic antigen (P = 0.014) and large tumors (P = 0.03). Marker migration to retroperitoneal and/or lateral pelvic nodes occurred in 37.1%, upstaging 11.1%. The markers' accuracy in the detection of metastatic retroperitoneal and/or lateral pelvic nodes was 100%.
Retroperitoneal and lateral pelvic lymphadenectomy detected an important rate of metastatic retroperitoneal and/or lateral pelvic nodes (RLPN), resulting in upstaging. When markers migrated, they were able to detect RLPN metastases. The use of markers should be improved in the identification of RLPN metastases for selective indication of retroperitoneal and lateral pelvic lymphadenectomy.
腹膜后和侧盆淋巴结清扫术的良好预后提出了这样一个问题，即全直肠系膜切除术是否适用于充分分期直肠腺癌患者。本研究的目的是确定染料和探针检测转移性腹膜后和/或侧盆淋巴结的准确性，并定义直肠腺癌患者腹膜后和侧盆淋巴结清扫术的分期影响。
97 例直肠腺癌患者接受全直肠系膜切除术和腹膜后及侧盆淋巴结清扫术。使用锝-99 m-植酸钠和专利蓝进行淋巴闪烁显像，以检测蓝色和/或放射性腹膜后和/或侧盆淋巴结，并用分步切片技术进行组织病理学和免疫组织化学检查。
直肠系膜平均淋巴结计数为 11.5 个，腹膜后和/或侧盆淋巴结为 11.7 个。腹膜后和侧盆淋巴结清扫术发现 17.5%的转移，分期增加 8.2%。与腹膜后和/或侧盆淋巴结转移相关的变量如下：全直肠系膜切除标本中的 III 期（P<0.04）、pT3/pT4 肿瘤（P=0.047）、癌胚抗原水平高（P=0.014）和肿瘤较大（P=0.03）。标记物向腹膜后和/或侧盆淋巴结迁移的发生率为 37.1%，分期增加 11.1%。标记物在检测腹膜后和/或侧盆淋巴结转移性病变中的准确性为 100%。
腹膜后和侧盆淋巴结清扫术检测到重要的腹膜后和/或侧盆淋巴结转移率（RLPN），导致分期增加。当标记物迁移时，它们能够检测到 RLPN 转移。应改进标记物在识别 RLPN 转移中的应用，以选择性指示腹膜后和侧盆淋巴结清扫术。
