Kwak Han Deok, Ju Jae Kyun, Yeom Seung-Seop, Lee Soo Young, Kim Chang Hyun, Kim Young Jin, Kim Hyeong Rok
Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.
Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Ann Surg Treat Res. 2020 Mar;98(3):139-145. doi: 10.4174/astr.2020.98.3.139. Epub 2020 Feb 28.
Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection.
Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution.
During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors.
For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.
右侧结肠癌的根治性淋巴结清扫术在技术上具有挑战性。目前尚无关于临床I期右侧结肠癌手术切除的明确指南。本研究旨在回顾临床I期右侧结肠癌的病理分期，并确定相关的手术切除范围。
2006年7月至2014年12月期间，在一家三级教学医院对临床I期右侧结肠癌（盲肠、升结肠、肝曲和近端横结肠）患者进行治疗。由于腹腔镜手术是该机构的主要初始手术，因此不包括开放手术。
在研究期间，80例诊断为临床I期右侧结肠癌的患者根据病理分为两组：0/I期和II/III期。II/III期组的肿瘤尺寸更大（P = 0.003）。II/III期组的血管侵犯率（P = 0.023）和淋巴侵犯率（P = 0.023）更高，高分化率更低（P = 0.022）。在随访期间，发现1例局部复发和4例全身复发。多因素分析以确定影响从临床I期转变为病理II/III期的优势比，结果显示肿瘤尺寸（P = 0.010）和获取的淋巴结数量（P = 0.046）是危险因素。
对于右侧结肠癌，即使包括临床I期，也应进行根治性淋巴结清扫术以进行准确分期，并获取足够数量的淋巴结。这将有助于确定合适的辅助治疗，尤其是对于肿瘤尺寸较大的情况。
