Dušek M, Chlumská A, Mukenšnabl P, Zámečník M
Sikluv patologicko-anatomicky ustav FN a LF UK v Plzni.
Rozhl Chir. 2013 May;92(5):250-4.
Optimized staging of colorectal carcinoma (CRC) is essential for treatment planning and for estimating the prognosis of the disease. In addition to tumour size and the depth of bowel wall infiltration, the lymph node status is very important for the determination of the disease stage. For this reason, detection and assessment of the maximum number of lymph nodes is emphasized in the examination of resected segments of the large bowel. The number of lymph nodes (LNs) found in the segments resected depends on various circumstances. In our study, we focused on factors which could influence the number of pericolic LNs.
We examined two groups of CRC patients. The first group included 30 patients within the age range of 32-50 years (average: 47.5 years) and the second group consisted of 90 patients aged between 51 and 87 years (average: 68 years). The tumours were localized in various parts of the colon, predominantly in the descending colon and the sigmoid colon. Rectal tumour was present in 23 patients; 13 of them underwent preoperative chemoradiation therapy and 10 of them received no preoperative therapy. The length of the resected colon segments (radical intervention) ranged from 6 to 51 cm. The size of CRC ranged from 0.5 to 15 cm (average: 4.5 cm). The maximum tumour invasion depth reached into the subserosal tissue and pericolic adipose tissue.
The number of LNs found in 120 resected colon segments ranged from 1 to 60 LNs per case. The number of LNs showed differences among the patients and also depended on the location of CRC within the large intestine. In the resected segments of the ceacum with CRC, the average number of LNs was 11.5, whereas it was only 7 in rectal CRC. The largest volume of pericolic adipose tissue was found in the caecum, whereas the smallest volume was seen on the rectal circumference. In CRC patients aged 50 years or younger, the number of LNs was from 2 to 60 (average: 17). In contrast, the number of LNs ranged from 1 to 46 (average: 11) in patients older than 50 years. In resected segments that were 6 to 12 cm long, the number of LNs ranged from 1 to 18 (average: 8). In resected segments that were 12 to 51 cm long, the number of LNs was from 1 to 60 (average: 13.8). In 13 cases of rectal CRC with preoperative chemoradiation therapy, small LNs of an average length of 1-3 mm predominated, and the number of LNs ranged between 1 and 13 (average: 5). The required number of 12 LNs was reached in 4 resected parts of the rectum (31%).
The number of pericolic LNs found in the resected segments of the colon and the rectum with CRC depends on various factors. Besides individual differences, the number of LNs is influenced by the CRC location in the colon, the extent of the resected pericolic adipose tissue, the patients age and the length of the segment resected. In cases of rectal CRCs, it is also influenced by preoperative chemoradiation therapy.
结直肠癌（CRC）的优化分期对于治疗规划和疾病预后评估至关重要。除肿瘤大小和肠壁浸润深度外，淋巴结状态对疾病分期的确定非常重要。因此，在大肠切除段的检查中，强调检测和评估最大数量的淋巴结。切除段中发现的淋巴结数量（LNs）取决于多种情况。在我们的研究中，我们关注了可能影响结肠旁淋巴结数量的因素。
我们检查了两组CRC患者。第一组包括30名年龄在32至50岁之间（平均：47.5岁）的患者，第二组由90名年龄在51至87岁之间（平均：68岁）的患者组成。肿瘤位于结肠的不同部位，主要在降结肠和乙状结肠。23例患者存在直肠肿瘤；其中13例接受了术前放化疗，10例未接受术前治疗。切除的结肠段长度（根治性手术）为6至51厘米。CRC大小为0.5至15厘米（平均：4.5厘米）。最大肿瘤浸润深度达浆膜下组织和结肠旁脂肪组织。
在120个切除的结肠段中发现的淋巴结数量为每例1至60个。淋巴结数量在患者之间存在差异，并且还取决于CRC在大肠内的位置。在患有CRC的盲肠切除段中，淋巴结的平均数量为11.5，而直肠CRC中仅为7个。结肠旁脂肪组织的最大体积见于盲肠，而最小体积见于直肠周围。50岁及以下的CRC患者中，淋巴结数量为2至60个（平均：17个）。相比之下，50岁以上患者的淋巴结数量为1至46个（平均：11个）。在长度为6至12厘米的切除段中，淋巴结数量为1至18个（平均：8个）。在长度为12至51厘米的切除段中，淋巴结数量为1至60个（平均：13.8个）。在13例接受术前放化疗的直肠CRC病例中，平均长度为1 - 3毫米的小淋巴结占主导，淋巴结数量在1至13个之间（平均：5个）。4个直肠切除部分（31%）达到了所需淋巴结数量为至少12个的要求。
在患有CRC的结肠和直肠切除段中发现的结肠旁淋巴结数量取决于多种因素。除个体差异外，淋巴结数量还受CRC在结肠中的位置、切除的结肠旁脂肪组织范围、患者年龄和切除段长度的影响。在直肠CRC病例中，它还受术前放化疗的影响。
