Lai Dong-ming, Li Ying-ru, Yang Bin, Zhang Yu-chao, Zhou Jun, Chen Shuang
Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Zhonghua Wai Ke Za Zhi. 2010 Jun 1;48(11):816-9.
To investigate the influence of lymph nodes detection on the pathological staging in rectal cancer specimens.
From January 2007 to June 2008, 75 patients with rectal cancer who underwent total mesorectal excision were randomly divided into two groups: conventional group (n = 39), in which lymph nodes were detected by sight and palpation; fat clearance group (n = 36), in which lymph nodes were harvested after the specimens immersed in a fat clearance solution for 24 hours. The lymph node number harvested was compared between the two groups, and metastasis of the lymph nodes and its impact on the pathologic staging was analyzed in the two groups.
A total of 75 patients (42 male and 33 female, the average age was 53.2 years) were enrolled in this study. In the conventional group, a mean of 14.4 lymph nodes (range, 8 - 27) was detected, and was significantly less than that in fat clearance group (mean 36.2, range, 18 - 62) (t = 5.800, P < 0.05). The tumor invasion was classified as T1 in 4 cases and 5 cases, T2 in 9 cases and 6 cases, T3 in 24 cases and 22 cases and T4 in 2 cases and 3 cases in conventional group and fat clearance group, respectively. No significant difference was found in T classification between the two groups (Z = 0.160, P = 0.850). The mean number of metastatic lymph nodes harvested in conventional group was 1.5, and it was 3.2 in the fat clearance group (Z = 3.500, P < 0.05). According to the regional lymph nodes, patients classified as N0, N1 and N2 were 20, 12, 7 cases in conventional group, and were 9, 14, 13 cases in the fat clearance group, respectively; and there was significant difference between the two groups (Z = 2.410, P = 0.016).
The variation of the number of harvested lymph nodes in surgical specimens from rectal cancer after total mesorectal excision is great. The metastasis of mesorectal lymph nodes is not only associated with the tumor staging, but also related to the number of harvested lymph nodes. It is questionable that 12 lymph nodes is currently seen as enough to evaluate the pathologic staging for rectal cancer.
探讨直肠癌标本中淋巴结检测对病理分期的影响。
2007年1月至2008年6月，75例行全直肠系膜切除术的直肠癌患者随机分为两组：传统组（n = 39），通过肉眼观察和触诊检测淋巴结；脂肪清除组（n = 36），标本浸入脂肪清除液24小时后收集淋巴结。比较两组收集的淋巴结数量，并分析两组淋巴结转移情况及其对病理分期的影响。
本研究共纳入75例患者（男42例，女33例，平均年龄53.2岁）。传统组平均检测到14.4个淋巴结（范围8 - 27个），明显少于脂肪清除组（平均36.2个，范围18 - 62个）（t = 5.800，P < 0.05）。传统组和脂肪清除组肿瘤侵犯分别为T1期4例和5例、T2期9例和6例、T3期24例和22例、T4期2例和3例。两组T分期差异无统计学意义（Z = 0.160，P = 0.850）。传统组收集到的转移淋巴结平均数为1.5个，脂肪清除组为3.2个（Z = 3.500，P < 0.05）。根据区域淋巴结情况，传统组N0、N1和N2分期患者分别为20例、12例、7例，脂肪清除组分别为9例、14例、13例；两组间差异有统计学意义（Z = 2.410，P = 0.016）。
全直肠系膜切除术后直肠癌手术标本中收集的淋巴结数量差异很大。直肠系膜淋巴结转移不仅与肿瘤分期有关，还与收集的淋巴结数量有关。目前认为12个淋巴结足以评估直肠癌病理分期这一观点值得质疑。
