Morohashi Hajime, Sakamoto Yoshiyuki, Miura Takuya, Ichinohe Daichi, Umemura Kotaro, Akaishi Takanobu, Sato Kentaro, Kuwata Daisuke, Yamazaki Keisuke, Wakiya Taiichi, Hakamada Kenichi
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan.
Int J Colorectal Dis. 2021 Jun;36(6):1251-1261. doi: 10.1007/s00384-021-03870-5. Epub 2021 Feb 1.
There are no reports showing the significance and effective range of dissection for patients with lateral lymph node metastasis (LLNM). This study aimed to investigate the indications for lateral lymph node dissection (LLND) in patients with LLNM based on prognostic factors and recurrence types.
We reviewed 379 patients with advanced rectal cancer who were treated with total mesorectal excision plus LLND. We analyzed background factors and survival times of patients who had LLNM to determine prognostic factors and recurrence types.
Pathological LLNM occurred in 44 (11.6%). Among patients with LLNM, the predictors of poor prognoses, according to univariate analysis, were > 3 node metastases, the presence of node metastasis on both sides, and spreading beyond the internal iliac lymph nodes. Moreover, LLNM beyond the internal iliac region was found to be an independent prognostic risk factor. Twenty-eight of the 44 patients with lateral lymph node metastasis (64%) relapsed, 22 of whom had distant metastases and 11 of whom experienced local recurrences. Among the latter group, nine (20%) and two (5%) had recurrences in the central and lateral pelvis, respectively.
The therapeutic benefit of resection was high, especially in patients with ≤ 3 positive lateral lymph nodes, one-sided bilateral lymph node areas, and positive nodes localized near the internal iliac artery.
尚无报告显示侧方淋巴结转移（LLNM）患者的清扫范围的意义及有效范围。本研究旨在基于预后因素和复发类型探讨LLNM患者行侧方淋巴结清扫（LLND）的指征。
我们回顾了379例行全直肠系膜切除加LLND治疗的晚期直肠癌患者。我们分析了发生LLNM患者的背景因素和生存时间，以确定预后因素和复发类型。
病理LLNM发生于44例（11.6%）。在发生LLNM的患者中，单因素分析显示预后不良的预测因素为淋巴结转移>3个、双侧存在淋巴结转移以及扩散至髂内淋巴结以外。此外，髂内区域以外的LLNM被发现是一个独立的预后危险因素。44例侧方淋巴结转移患者中有28例（64%）复发，其中22例有远处转移，11例有局部复发。在后一组中，分别有9例（20%）和2例（5%）在中央骨盆和侧方骨盆复发。
切除的治疗益处较高，尤其是对于侧方淋巴结阳性数≤3个、单侧或双侧淋巴结区域以及阳性淋巴结位于髂内动脉附近的患者。
