Park Byung Kwan, Lee Sang Jae, Hur Bo Yun, Kim Min Ju, Chan Park Sung, Chang Hee Jin, Kim Dae Yong, Oh Jae Hwan
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
J Surg Res. 2018 Dec;232:227-233. doi: 10.1016/j.jss.2018.05.047. Epub 2018 Jul 11.
Lateral pelvic node metastasis is one of the major causes of local recurrence in advanced rectal cancer after preoperative chemoradiotherapy (CRT). However, lateral pelvic node dissection (LPND) is still a challenging surgical procedure in terms of surgical morbidity. This study aimed to investigate the feasibility and safety of LPND in patients with advanced rectal cancer after preoperative CRT.
Records of 80 consecutive patients who underwent total mesorectal excision (TME) with LPND for initially enlarged lateral pelvic nodes (LPNs) (short-axis diameter ≥5 mm on magnetic resonance imaging before preoperative CRT) between 2011 and 2016 were retrospectively reviewed. Surgical outcomes of these patients were compared with those of 281 patients who underwent TME alone.
Ninety-nine LPND procedures were performed, including 19 bilateral LPNDs. Pathologically proven LPN metastasis was identified in 32 (32.3%) LPND cases after preoperative CRT. Multiple (odds ratio = 12.908, 95% confidence interval: 3.355-49.660, P < 0.001) and persistently enlarged LPNs (odds ratio = 27.093, 95% confidence interval: 6.072-120.896, P < 0.001) were independently associated with LPN metastasis. The rates of overall postoperative 30-d morbidity (42.5% versus 32.4%, P = 0.093) and urinary retention (11.3% versus 7.1%, P = 0.230) were similar between the TME with LPND and TME-only groups.
The postoperative morbidity of TME with LPND was comparable with TME-only group. The rate of LPN metastasis remained high after preoperative CRT, especially in patients with multiple or persistently enlarged LPNs.
盆腔侧方淋巴结转移是晚期直肠癌术前放化疗（CRT）后局部复发的主要原因之一。然而，盆腔侧方淋巴结清扫术（LPND）在手术并发症方面仍是一项具有挑战性的手术。本研究旨在探讨LPND在术前CRT后的晚期直肠癌患者中的可行性和安全性。
回顾性分析2011年至2016年间连续80例因最初盆腔侧方淋巴结（LPNs）肿大（术前CRT前磁共振成像短轴直径≥5mm）而接受全直肠系膜切除术（TME）联合LPND的患者记录。将这些患者的手术结果与281例仅接受TME的患者进行比较。
共进行了99例LPND手术，包括19例双侧LPND。术前CRT后，32例（32.3%）LPND病例经病理证实有LPN转移。多个（比值比=12.908，95%置信区间：3.355-49.660，P<0.001）和持续肿大的LPNs（比值比=27.093，95%置信区间：6.072-120.896，P<0.001）与LPN转移独立相关。TME联合LPND组与单纯TME组术后30天总体并发症发生率（42.5%对32.4%，P=0.093）和尿潴留发生率（11.3%对7.1%，P=0.230）相似。
TME联合LPND的术后并发症与单纯TME组相当。术前CRT后LPN转移率仍然很高，尤其是在有多个或持续肿大LPNs的患者中。
