Zhou Zhongyi, Zhu Hong, Liu Wenxue, Tan Fengbo, Pei Qian, Zhao Lilan, Li Chenglong, Wang Dan, Zhou Yuan, Peng Huan, Pei Haiping, Li Yuqiang
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of Radiotherapy, Xiangya Hospital, Central South University, Changsha, China.
J Cancer. 2021 Mar 5;12(9):2513-2525. doi: 10.7150/jca.52352. eCollection 2021.
The guidelines for colon cancer surgery have been evolving over the past three decades. The advances in colectomy have focused mainly on the number of regional nodes evaluated (RNE). Data in this retrospective analysis were extracted from the Surveillance, Epidemiology, and End Results (SEER) linked database. Rapid growth of RNE (the median rising from 10 (6-16) to 17 (13-23)) occurred from 2000 to 2009. The rate of colon cancer patients with positive lymph nodes following colectomy was greatly decreasing only in the group with RNE greater than 12 after 2000. Patients with T4 and/or N+ cannot obtain survival benefit from the increasing trend of RNE. The apparent survival benefit for T1-3N0 patients may result from augmented false negatives in patients from previous periods. The golden period of surgical development in colon cancer, using RNE as an alternative indicator, occurred in the first decade of the 21st century. Although a more extensive lymph node evaluation is able to reduce the risk of underestimated staging, the increase of RNE does not provide survival benefits for locoregional colon cancer. A proper reduction in the scope of lymph node dissection may be reasonable in radical surgery for colon cancer.
在过去三十年中，结肠癌手术指南一直在不断发展。结肠切除术的进展主要集中在评估的区域淋巴结数量（RNE）上。本回顾性分析的数据取自监测、流行病学和最终结果（SEER）关联数据库。2000年至2009年期间，RNE迅速增长（中位数从10（6 - 16）升至17（13 - 23））。2000年后，仅在RNE大于12的组中，结肠切除术后淋巴结阳性的结肠癌患者比例大幅下降。T4和/或N +患者无法从RNE的增加趋势中获得生存益处。T1 - 3N0患者明显的生存益处可能源于前期患者中增加的假阴性。以RNE作为替代指标，结肠癌手术发展的黄金时期出现在21世纪的第一个十年。虽然更广泛的淋巴结评估能够降低分期低估的风险，但RNE的增加并未为局部结肠癌患者带来生存益处。在结肠癌根治手术中，适当缩小淋巴结清扫范围可能是合理的。
