Lee Soo Young, Yeom Seung-Seop, Kim Chang Hyun, Kim Young Jin, Kim Hyeong Rok
Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
ANZ J Surg. 2019 Sep;89(9):E373-E378. doi: 10.1111/ans.15400. Epub 2019 Aug 26.
The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. We designed this study to evaluate the distribution of lymph node metastasis and the appropriate extent of lymph node dissection in descending colon cancer patients.
We retrospectively reviewed the medical records of 118 descending colon cancer patients without distant metastasis, who underwent curative resection between January 2004 and December 2014. The distribution of lymph node metastasis was evaluated, and prognostic factors were analysed.
The median follow-up period was 52 months (range 1-125 months). Twenty-six (22.0%) patients underwent high ligation of the inferior mesenteric artery (IMA), whereas 92 (78.0%) patients underwent ligation of the left colic artery, saving the IMA. Lymph nodes at the origin of the IMA showed no metastasis in any of the 26 patients who underwent high ligation of the IMA. After propensity score matching, 3-year disease-free survival (80.4% versus 92.9%, P = 0.471) and 5-year overall survival (81.8% versus 90.9%, P = 0.875) were not significantly different according to the type of IMA ligation.
In patients with descending colon cancer, there was no lymph node metastasis at the origin of the IMA, and ligation of the IMA showed no prognostic benefit.
降结肠癌患者淋巴结清扫的最佳范围仍存在争议。我们设计了本研究，以评估降结肠癌患者淋巴结转移的分布情况以及淋巴结清扫的合适范围。
我们回顾性分析了2004年1月至2014年12月期间接受根治性切除的118例无远处转移的降结肠癌患者的病历。评估淋巴结转移的分布情况，并分析预后因素。
中位随访期为52个月（范围1 - 125个月）。26例（22.0%）患者接受了肠系膜下动脉（IMA）高位结扎，而92例（78.0%）患者结扎了左结肠动脉，保留了IMA。在接受IMA高位结扎的26例患者中，IMA起始处的淋巴结均无转移。倾向评分匹配后，根据IMA结扎类型，3年无病生存率（80.4%对92.9%，P = 0.471）和5年总生存率（81.8%对90.9%，P = 0.875）无显著差异。
在降结肠癌患者中，IMA起始处无淋巴结转移，结扎IMA未显示出预后益处。
