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结直肠癌原发灶切除术中淋巴结清扫的再评价。

A reappraisal of lymph node dissection in colorectal cancer during primary surgical resection.

机构信息

Department of Surgery, Taipei Hospital, Ministry of Health and Welfare, No. 127, Su-Yuan Road, Hsin-Chuang Dist., New Taipei City, Taiwan.

Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Bei-Tou Dist., Taipei, Taiwan.

出版信息

World J Surg Oncol. 2020 May 17;18(1):97. doi: 10.1186/s12957-020-01863-2.


DOI:10.1186/s12957-020-01863-2
PMID:32418536
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7232835/
Abstract

PURPOSE: Controversy exists regarding the extent to which lymph node dissection (LND) should be performed for operable colorectal cancers (CRCs) during primary surgical resection. We reappraised the role of LND in CRCs. METHODS: Seventy-three CRC patients (mean age, 65.3 years; 43 males) undergoing primary surgical resection at Taipei Hospital, Ministry of Health and Welfare, Taiwan, within a 3-year period were retrospectively analyzed. Their pathological T/N/M statuses and cancer stages were defined according to the American Joint Committee on Cancer (AJCC) 8th edition staging system. The numbers of total dissected lymph nodes (TDLNs), positive dissected lymph nodes (PDLNs), and negative dissected lymph nodes (NDLNs) for each CRC patient were recorded in detail (TDLNs = PDLNs + NDLNs). Possible prognostic variables were evaluated. RESULTS: An advanced N status (N1/N2 vs. N0; HR, 5.749/17.677 vs. 1.000; p = 0.056/0.009) and M1 status (M1 vs. M0; HR, 7.517 vs. 1.000; p = 0.010) were independent variables for a poor prognosis. For all 73 CRC patients (p = 0.030), as well as T2 CRC patients (p = 0.061), those with > 15 TDLNs tended to have more PDLNs than those with ≤ 15 TDLNs. For 42 N(+) CRC patients (p = 0.007), as well as N2 CRC patients (p = 0.011), those with > 21 TDLNs tended to have more PDLNs than those with ≤ 21 TDLNs. CONCLUSION: For CRC patients undergoing primary surgical resection, the number of TDLNs influences the accuracy of nodal staging. A minimum of 15 TDLNs is necessary for positive lymph nodes to be identified in CRC patients, and 21 TDLNs is sufficient for the severity of the N(+) status to be distinguished in N(+) CRC patients.

摘要

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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c204/7232835/9952ad05f48d/12957_2020_1863_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c204/7232835/9952ad05f48d/12957_2020_1863_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c204/7232835/9952ad05f48d/12957_2020_1863_Fig1_HTML.jpg

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[8]
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本文引用的文献

[1]
Positive impact of the negative lymph node count on the survival rate of stage III colon cancer with pN1 and right-side disease.

J Cancer. 2019-1-29

[2]
Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study.

Gastroenterol Res Pract. 2019-1-22

[3]
A study of morphological prognostic factors in colorectal cancer and survival analysis.

Indian J Pathol Microbiol. 2019

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Comparison of the eighth version of the American Joint Committee on Cancer manual to the seventh version for colorectal cancer: A retrospective review of our data.

World J Clin Oncol. 2018-11-10

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The Risk Factors Affecting Survival in Colorectal Cancer in Taiwan.

Iran J Public Health. 2018-4

[6]
Prognostic value of total number of lymph nodes retrieved differs between left-sided colon cancer and right-sided colon cancer in stage III patients with colon cancer.

BMC Cancer. 2018-5-11

[7]
AJCC 8th Edition: Colorectal Cancer.

Ann Surg Oncol. 2018-6

[8]
The prognosis role of AJCC/UICC 8 edition staging system in gastric cancer, a retrospective analysis.

Am J Transl Res. 2018-1-15

[9]
Survival impact of the number of lymph node retrieved on patients with node-negative gastric cancer: more is better?

Transl Gastroenterol Hepatol. 2017-12-7

[10]
8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice.

Ann Cardiothorac Surg. 2017-3

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