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影响直肠癌腹腔镜切除标本淋巴结获取量的临床病理因素

[Clinicopathological factors affecting the lymph node yield from laparoscopically resected specimens of rectal cancer].

作者信息

Liu X, Ma J, Liu Q, Zhou Z X

机构信息

Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.

State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2016 Dec 23;38(12):915-919. doi: 10.3760/cma.j.issn.0253-3766.2016.12.007.

Abstract

To identify the clinicopathological factors affecting the number of lymph nodes yielded from specimens obtained by laparoscopic-assissted resection of rectal cancer, and discuss further the possible causes of insufficient lymph nodes retrieval (<12). The clinicopathological data of 422 consecutive rectal cancer cases, who underwent radical laparoscopic rectal resection (R0) at our department during January to October 2015, were analyzed retrospectively. The correlation between the clinicopathological factors and the number of lymph nodes yielded from the surgical specimens was assessed statistically. Age of the patient, length of specimen, tumor size and operating surgeon were significantly associated with the lymph node yield (all <0.05). The total number of lymph nodes yielded in 351 patients without neoadjuvant therapy ranged 8-49, with an average of 22.5, and the lymph node metastasis rate was 0-100% with an average of 7.6%.The total number of lymph nodes yielded from the 71 patients receiving neoadjuvant therapy ranged 9-70, with an average of 18.3, and the lymph node metastasis rate was 0-73.0%, with an average of 7.6%. Neoadjuvant therapy decreased the total lymph node yield obviously (<0.001), but didn't decrease the lymph node metastasis rate (=0.636). Of all the patients investigated, 19 cases had less than 12 dissected lymph nodes, and 403 cases had at least 12 lymph nodes removed. Gender, tumor size and neoadjvant therapy were independent risk factors for yield of twelve or more lymph nodes (all <0.05). Age of the patient, length of specimen, tumor size, operating surgeons and neoadjuvant therapy are significantly correlated with the total number of lymph nodes yielded from laparoscopically resected specimens of rectal cancer. Neoadjvant therapy may obviously decrease the number of yielded lymph nodes, while not decreases the lymph node metastasis rate. Male gender, small size of the tumor, and neoadjvant therapy are possible risk factors for harvesting less than 12 lymph nodes.

摘要

为确定影响腹腔镜辅助直肠癌切除术标本获取淋巴结数量的临床病理因素,并进一步探讨淋巴结获取不足(<12枚)的可能原因。回顾性分析了2015年1月至10月在我科接受根治性腹腔镜直肠癌切除术(R0)的422例连续直肠癌病例的临床病理资料。对临床病理因素与手术标本获取淋巴结数量之间的相关性进行了统计学评估。患者年龄、标本长度、肿瘤大小和手术医生与淋巴结获取量显著相关(均<0.05)。351例未接受新辅助治疗患者获取的淋巴结总数为8 - 49枚,平均22.5枚,淋巴结转移率为0 - 100%,平均7.6%。71例接受新辅助治疗患者获取的淋巴结总数为9 - 70枚,平均18.3枚,淋巴结转移率为0 - 73.0%,平均7.6%。新辅助治疗明显降低了淋巴结获取总量(<0.001),但未降低淋巴结转移率(=0.636)。在所有研究患者中,19例解剖的淋巴结少于12枚,403例至少切除了12枚淋巴结。性别、肿瘤大小和新辅助治疗是获取12枚及以上淋巴结的独立危险因素(均<0.05)。患者年龄、标本长度、肿瘤大小、手术医生和新辅助治疗与腹腔镜直肠癌切除标本获取的淋巴结总数显著相关。新辅助治疗可能明显减少获取的淋巴结数量,而不降低淋巴结转移率。男性、肿瘤体积小和新辅助治疗是获取少于12枚淋巴结的可能危险因素。

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