Patel Sunil V, Patel Sanjay V B, Brackstone Muriel
The Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont.
The Department of Surgery, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ont.
Can J Surg. 2014 Oct;57(5):349-53. doi: 10.1503/cjs.019313.
BACKGROUND: It has been suggested that inadequate lymph node harvest may result in pathologically understaged or indeterminate staging of patients with colorectal cancer (CRC). We compared the adequacy of nodal staging in patients undergoing emergency surgery compared with elective surgery for CRC. METHODS: Using a prospectively collected CRC surgery database at a tertiary care centre, we performed a cohort study. The mean number of lymph nodes harvested and the proportion of patients who had inadequate staging (< 12 nodes harvested) were compared between emergency and elective surgery cohorts. Our analysis was adjusted for tumour site, type of resection, surgical training and pathologic stage. RESULTS: A total of 1279 of 1356 (94%) enrolled patients had nodal data available for analysis; 161 (13%) patients had emergency surgery and 1118 (87%) had elective surgery. The mean number of nodes removed was higher in the emergency surgery group (mean difference +2.8, 95% confidence interval [CI] 0.6-5.1, p = 0.012). The proportion of patients with inadequate nodal staging did not differ between groups (emergent 16%, elective 17%, p = 0.79). The odds of adequate nodal staging, adjusting for site, type of resection, training and stage was no different between groups (OR 0.80, 95% CI 0.47-1.35, p = 0.41). CONCLUSION: The evidence does not support the common belief that emergency surgery is more commonly understaged in CRC. Our data suggest emergency surgery resulted in a significant increase in the average number of nodes harvested, with no difference in inadequate nodal staging.
背景:有人提出,淋巴结清扫不充分可能导致结直肠癌(CRC)患者病理分期过低或分期不确定。我们比较了接受急诊手术与择期手术的CRC患者淋巴结分期的充分性。 方法:利用一家三级医疗中心前瞻性收集的CRC手术数据库,我们进行了一项队列研究。比较了急诊手术队列和择期手术队列中收获的淋巴结平均数量以及分期不充分(收获淋巴结<12个)的患者比例。我们的分析对肿瘤部位、切除类型、手术培训和病理分期进行了调整。 结果:1356名登记患者中有1279名(94%)有可供分析的淋巴结数据;161名(13%)患者接受了急诊手术,1118名(87%)接受了择期手术。急诊手术组切除的淋巴结平均数量更高(平均差异+2.8,95%置信区间[CI]0.6 - 5.1,p = 0.012)。两组之间分期不充分的患者比例没有差异(急诊组16%,择期组17%,p = 0.79)。在对部位、切除类型、培训和分期进行调整后,两组之间淋巴结分期充分的几率没有差异(OR 0.80,95% CI 0.47 - 1.35,p = 0.41)。 结论:证据不支持急诊手术在CRC中更常出现分期过低的普遍观点。我们的数据表明,急诊手术使收获的淋巴结平均数量显著增加,而在分期不充分方面没有差异。
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