Bedzhanyan A L, Bredikhin M I, Galyan T N, Arutyunyants D E, Petrenko K N, Dolzhansky O V, Frolova Yu V, Linnik D V
Petrovsky Russian Scientific Center of Surgery, Moscow, Russia.
Khirurgiia (Mosk). 2021(6. Vyp. 2):95-100. doi: 10.17116/hirurgia202106295.
Metastases of the right colon cancer to extra-regional lymph nodes are rarely observed. Available literature data cannot be a reliable guide to choose the optimal treatment strategy. Indeed, excision of extra-regional lymph nodes is a rare experience and its results are poorly represented. According to our clinical experience, surgical intervention following comprehensive examination may be radical in patients with right colon cancer if distant metastases are absent. Resection of extra-regional lymph nodes can be safely performed in these cases. We report a patient with the right colon cancer and lesion of extra-regional lymph nodes behind the pancreatic head, paracaval and paraaortic space, hepatoduodenal ligament. Standard laparoscopic right-sided hemicolectomy with D-3 lymph node dissection was accompanied by resection of a conglomerate of nodal metastases behind the pancreatic head and superficial resection of the pancreas. Extra-regional lymph node excision is a reasonable option for colon mucinous adenocarcinoma stage I-III. However, comprehensive preoperative examination is required. Technical difficulty of extra-regional lymph node excision it is not the reason for limitation of surgical intervention. However, safe and total resection requires an adequate surgical approach.
右结肠癌转移至区域外淋巴结的情况很少见。现有的文献数据无法成为选择最佳治疗策略的可靠指南。实际上，切除区域外淋巴结的经验很少，其结果也鲜有报道。根据我们的临床经验，如果没有远处转移，对于右结肠癌患者，综合检查后的手术干预可能是根治性的。在这些情况下，可以安全地进行区域外淋巴结切除术。我们报告了一例右结肠癌患者，其区域外淋巴结病变位于胰头后方、腔静脉旁和主动脉旁间隙、肝十二指肠韧带。标准腹腔镜右侧半结肠切除术加D-3淋巴结清扫术，同时切除胰头后方的一组淋巴结转移灶并对胰腺进行浅表切除。对于Ⅰ-Ⅲ期结肠黏液腺癌，区域外淋巴结切除是一种合理的选择。然而，术前需要进行全面检查。区域外淋巴结切除的技术难度并非限制手术干预的原因。然而，安全的全切除需要适当的手术入路。
