Digestive Disease Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave. / A 30, 44195, Cleveland, OH, USA.
World J Surg. 2013 Aug;37(8):1789-98. doi: 10.1007/s00268-013-2130-6.
No one doubts that lymph node dissection in colon cancer is necessary, it is just the extent of that dissection that is still under debate. As the individual steps of an oncologic operation cannot be separated from each other, analysis of the significance of lymph node dissection alone is difficult. It has been proven that the T category is directly related to the number and central spread of lymph node metastases. Micrometastases and isolated tumor cells may be detected in lymph nodes by using special staining techniques; their presence may worsen prognosis significantly and approximate it to UICC stage III. The numbers of dissected lymph nodes and the ratio of involved versus dissected lymph nodes have been used as markers for quality of surgery and histopathological evaluation. Recent results underscore the importance of technique and extent of dissection. Dissection must be performed along the embryologic planes of the mesocolon and leave them intact. A high vascular tie with preservation of the central hypogastric nerves must be applied in order to achieve the best oncologic results while preserving quality of life. Extended lymphadenectomy is oncologically relevant only when it is combined with removal of the primary tumor with adequate longitudinal clearance, an intact complete mesocolon, and high vascular tie. It is part of a concept in which the tumor-bearing specimen is harvested as an enveloped package to minimize the risk of tumor cell spillage and local recurrence.
没有人怀疑结肠癌淋巴结清扫术是必要的，只是清扫的范围仍存在争议。由于肿瘤手术的各个步骤彼此之间不能分开，因此单独分析淋巴结清扫的意义是困难的。已经证明，T 分期与淋巴结转移的数量和中央扩散直接相关。通过使用特殊的染色技术，可以在淋巴结中检测到微转移和孤立肿瘤细胞；它们的存在可能会显著恶化预后，使其接近 UICC 分期 III 期。淋巴结清扫的数量和阳性淋巴结与清扫淋巴结的比例已被用作手术质量和组织病理学评估的标志物。最近的结果强调了手术技术和范围的重要性。清扫必须沿着结肠系膜的胚胎平面进行，并保持其完整。为了获得最佳的肿瘤学结果并保留生活质量，必须进行高血管结扎，同时保留中下腹神经。只有当淋巴结清扫术与原发肿瘤的切除相结合，同时保证足够的纵向清扫、完整的完整结肠系膜和高血管结扎时，才能实现肿瘤学的相关性。它是一个概念的一部分，其中包含肿瘤的标本被作为一个包裹的包裹物采集，以最大程度地降低肿瘤细胞溢出和局部复发的风险。
