Department of Gastroenterological Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Department of Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Int J Colorectal Dis. 2021 Feb;36(2):293-301. doi: 10.1007/s00384-020-03760-2. Epub 2020 Sep 23.
Lateral lymph node dissection (LLND) has been considered as the standard treatment strategy for locally advanced lower rectal cancer in Japan. Controversy remains around whether all patients require LLND. This study aims to examine the long-term outcomes of patients in which LLND was performed and clarify the value of LLND.
Consecutive 458 patients with lower rectal cancer who underwent total mesorectal excision (TME) plus LLND from 1992 to 2012 were included. The long-term outcomes and risk factors for recurrent in patients performed TME + LLND were examined. We assessed the impact of LLND on survival using an estimated therapeutic index.
The incidence of LLNM was 15.5%. The 5-year RFS and OS rates of patients with LLNM were 40.9% and 47.7%, while patients without LLNM had a good prognosis. The 5-year local recurrence (LR) rate was 9.2%, and independent risk factors for LR were T4 and LLNM. The LR rate of patients with LLNM was high (22.8%). The LLNM rate of the groups with 0, 1, 2, 3, or 4 risk factors (male, tumor location < 4 cm from anal verge, T4, and MLNM) was 3.8%, 9.2%, 18.1%, and 50.0%. The 5-year OS of the groups was 96.2%, 86.1%, 69.7%, and 48.5%.
Although patients with locally advanced lower rectal cancer who received LLND had a good prognosis, LLND alone was insufficient to control local recurrence in patients with metastatic lateral nodes.
在日本，对于局部进展期低位直肠癌，侧方淋巴结清扫（LLND）被认为是标准的治疗策略。是否所有患者都需要进行 LLND 仍存在争议。本研究旨在观察接受 LLND 的患者的长期疗效，明确 LLND 的价值。
连续纳入 1992 年至 2012 年期间接受全直肠系膜切除术（TME）加 LLND 的 458 例低位直肠癌患者。分析 TME+LLND 患者的复发相关长期生存结局及危险因素，采用治疗获益指数评估 LLND 对生存的影响。
LLNM 发生率为 15.5%。有 LLNM 患者的 5 年 RFS 和 OS 率分别为 40.9%和 47.7%，而无 LLNM 患者预后良好。5 年局部复发（LR）率为 9.2%，LR 的独立危险因素为 T4 和 LLNM。有 LLNM 患者的 LR 率较高（22.8%）。0、1、2、3、4 个危险因素（男性、肿瘤距肛缘＜4cm、T4、MLNM）患者的 LLNM 发生率分别为 3.8%、9.2%、18.1%和 50.0%，5 年 OS 率分别为 96.2%、86.1%、69.7%和 48.5%。
虽然接受 LLND 的局部进展期低位直肠癌患者预后良好，但单纯 LLND 不足以控制转移性侧方淋巴结患者的局部复发。
