不同部位右半结肠癌患者末端回肠系膜淋巴结转移的临床意义。

Clinical Significance of Lymph Node Metastasis in the Mesentery of the Terminal Ileum in Patients With Right-sided Colon Tumors at Different Locations.

机构信息

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.

出版信息

Dis Colon Rectum. 2018 Jun;61(6):692-697. doi: 10.1097/DCR.0000000000001048.

DOI:10.1097/DCR.0000000000001048

PMID:29664799

Abstract

BACKGROUND

There are limited reports on peri-ileal lymph node metastasis in patients with right-sided colon cancer, and little is known about their clinical significance.

OBJECTIVE

This study aimed to examine the role of tumor location in the prevalence and clinical significance of peri-ileal lymph node metastasis in patients with right-sided colon cancer.

DESIGN

This is a retrospective study from a prospective cohort database.

SETTINGS

The study was conducted at a tertiary referral hospital.

PATIENTS

Patients with right-sided colon cancer treated with radical surgery in a hospital between May 2006 and September 2016 were included.

MAIN OUTCOME MEASURES

The frequency of peri-ileal lymph node metastasis in the study cohort and the role of tumor location and the clinical characteristics of patients with peri-ileal lymph node metastasis were determined.

RESULTS

We examined 752 cases with right-sided colon cancer including 82 cecal, 554 ascending colon, and 116 hepatic flexure cancer. Twenty patients (2.7%) had peri-ileal lymph node metastasis. The incidence of metastasis to peri-ileal lymph nodes was 7.3% (6/82) in patients with cecal cancer, 2.2% (12/554) in patients with ascending colon cancer, and 1.7% (2/116) in patients with hepatic flexure cancer. Three patients had stage III cancer and 17 had stage IV. All 3 patients with positive peri-ileal lymph nodes and stage III cancer had cecal tumors. In contrast, all patients with ascending colon or hepatic flexure cancer and positive peri-ileal lymph nodes had stage IV cancer.

LIMITATIONS

The results were limited by the retrospective design of the study and the small number of patients with peri-ileal lymph node metastasis.

CONCLUSIONS

Peri-ileal lymph node metastasis was rare even in right-sided colon cancer and occurred mainly in stage IV. However, it occurred in some patients with locally advanced cecal cancer. These results suggest that optimal resection of the mesentery of the terminal ileum might have clinical benefit, especially in curative surgery for cecal cancer. See Video Abstract at http://links.lww.com/DCR/A556.

摘要

背景

右侧结肠癌患者的回肠旁淋巴结转移的报道有限，其临床意义知之甚少。

目的

本研究旨在探讨肿瘤位置在右侧结肠癌患者回肠旁淋巴结转移的发生率和临床意义中的作用。

设计

这是一项来自前瞻性队列数据库的回顾性研究。

地点

研究在一家三级转诊医院进行。

患者

纳入 2006 年 5 月至 2016 年 9 月期间在医院接受根治性手术治疗的右侧结肠癌患者。

主要观察指标

研究队列中回肠旁淋巴结转移的频率以及肿瘤位置和回肠旁淋巴结转移患者的临床特征的作用。

结果

我们检查了 752 例右侧结肠癌患者，包括 82 例盲肠、554 例升结肠癌和 116 例肝曲癌。20 例（2.7%）患者发生回肠旁淋巴结转移。盲肠癌患者的转移至回肠旁淋巴结的发生率为 7.3%（6/82），升结肠癌患者为 2.2%（12/554），肝曲癌患者为 1.7%（2/116）。3 例患者为 III 期癌症，17 例为 IV 期。所有 3 例阳性回肠旁淋巴结和 III 期癌症患者均为盲肠肿瘤。相比之下，所有具有阳性回肠旁淋巴结和升结肠癌或肝曲癌的患者均为 IV 期癌症。