Department of Colorectal Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
J Surg Oncol. 2010 Sep 1;102(3):230-4. doi: 10.1002/jso.21606.
Lateral lymph node (LLN) metastasis sometimes occurs in patients with early rectal cancer that has invaded the submucosa (SM) and muscularis propria (MP). This study aims to identify the risk factor(s) for LLN metastasis in such patients.
We retrospectively analyzed 65 patients with pathological SM or MP lower rectal adenocarcinoma, for whom radical resection had been performed at a single institution.
We performed LLN dissection in 52 (80%) patients. The LLN dissection rates in the case of pathological SM and MP tumors were 65.6% and 94.4%, respectively, and the corresponding LLN metastasis rates were 6.9% and 11.1%. Severe tumor budding was found to be a risk factor for LLN metastasis (P = 0.002). Further, of six patients with LLN metastasis, four did not have coincident mesenteric lymph node metastasis.
In rectal cancer that has pathologically invaded SM and MP, LLN metastasis is not negligible. LLN dissection could lower the local recurrence rate of SM and MP rectal cancer. In case LLN dissection is not performed, patients with a high tumor budding grade should be administered adjuvant therapy.
黏膜下浸润（SM）和固有肌层浸润（MP）的早期直肠癌有时会发生侧方淋巴结（LLN）转移。本研究旨在确定此类患者发生 LLN 转移的危险因素。
我们回顾性分析了在单机构接受根治性切除术的 65 例病理 SM 或 MP 低位直肠腺癌患者。
我们对 52 例（80%）患者进行了 LLN 清扫。病理 SM 和 MP 肿瘤的 LLN 清扫率分别为 65.6%和 94.4%，相应的 LLN 转移率分别为 6.9%和 11.1%。重度肿瘤芽是 LLN 转移的危险因素（P = 0.002）。此外，6 例 LLN 转移患者中，有 4 例没有合并肠系膜淋巴结转移。
在病理上已经侵犯 SM 和 MP 的直肠癌中，LLN 转移不容忽视。LLN 清扫术可降低 SM 和 MP 直肠癌的局部复发率。如果未行 LLN 清扫术，应给予高肿瘤芽分级患者辅助治疗。
