Hermanek P, Giedl J
Abteilung für Klinische Pathologie, Chirurgischen Universitätsklinik Erlangen.
Wien Med Wochenschr. 1988 Jun 30;138(11-12):292-6.
The incidence of regional lymph node metastases in colorectal carcinoma is influenced primarily by depth of invasion, but also by histological grade of malignancy and histologically demonstrable invasion of lymphatics. With regard to the indication for limited treatment of colorectal carcinoma, a differentiation between high risk and low risk tumors is recommended. In 6% of tumors with regional lymph node metastases only micrometastases are observed whose prognostic significance is not yet established. In most cases, lymphatic spread occurs regularly, in conformity with the anatomical situation, skipping of lymph nodes in less than 2% of cases with lymph node metastasis can be observed. The incidence and topography of lymph node metastases are important for the choice of surgical procedures. Because of the observed behaviour in lymphatic spread extended hemicolectomies are recommended for tumors of the transverse colon and the colonic flexures. The surgical treatment of rectal carcinoma should include the systematic node dissection along the inferior mesenteric artery.
结直肠癌区域淋巴结转移的发生率主要受浸润深度影响，但也受恶性组织学分级和淋巴管组织学可证实浸润的影响。关于结直肠癌有限治疗的指征，建议区分高风险和低风险肿瘤。在仅出现区域淋巴结转移的肿瘤中，6%的病例仅观察到微转移，其预后意义尚未明确。在大多数情况下，淋巴转移呈规律性发生，与解剖情况相符，在不到2%的有淋巴结转移的病例中可观察到淋巴结跳跃转移。淋巴结转移的发生率和部位对于手术方式的选择很重要。鉴于观察到的淋巴转移行为，对于横结肠和结肠弯曲处的肿瘤，建议行扩大半结肠切除术。直肠癌的手术治疗应包括沿肠系膜下动脉进行系统性淋巴结清扫。
