Feng Xiaochuang, Li Hongming, Lu Xinquan, Yi Xiaojiang, Wan Jin, Liao Weilin, Wang Jiahao, Ke Yisen, Tan Ping, Chen Jialiang, Liu Tianwen, Hong Xiaoyan, Diao Dechang
Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine No. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China.
Department of Radiology, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine No. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China.
Am J Cancer Res. 2021 May 15;11(5):2095-2105. eCollection 2021.
Distribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate. In this study, Carbon Nanoparticles (CNs) and Indocyanine Green (ICG) were used for regional LNs mapping by preoperative colonoscopic tattooing (PCT) and we laparoscopically observed the stained LNs distribution pattern. Lastly, 143 RCC patients who received a "superior mesenteric artery (SMA)-oriented" hemicolectomy were included to calculate the probability of LNs metastasis in our target area. 27 patients diagnosed as RCC (mean age 58.04 years, 17 male) were included. 14 patients underwent CNs injection and 13 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 22 cases (81.48%), posterior to SMV area in 6 cases (22.22%), and anterior to SMA in 16 cases (59.26%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (χ = 4.24, ). The probability of LNs metastasis in the above areas (target areas) was 2.10% (3/143). In conclusion, right-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of removing mesenteric tissue in our target area on lymphatic resection.
区域淋巴结（LNs）的分布对于右侧结肠癌（RCC）根治性切除术中淋巴结清扫边界具有决定性作用。目前，中央区域淋巴结的数据仍不明确且稀缺。在此，我们旨在对RCC患者肠系膜上血管周围的淋巴结进行更详细的解剖学研究，并调查转移率。在本研究中，通过术前结肠镜下纹身（PCT）使用碳纳米颗粒（CNs）和吲哚菁绿（ICG）进行区域淋巴结定位，我们通过腹腔镜观察染色淋巴结的分布模式。最后，纳入143例行“肠系膜上动脉（SMA）导向”半结肠切除术的RCC患者，以计算我们目标区域淋巴结转移的概率。纳入27例诊断为RCC的患者（平均年龄58.04岁，男性17例）。14例患者接受了CNs注射，13例患者同意使用ICG，4例出现成像失败。分别在22例（81.48%）中检测到位于肠系膜上静脉（SMV）和SMA之间的区域淋巴结数量不等，6例（22.22%）位于SMV区域后方，16例（59.26%）位于SMA前方。SMV后方淋巴结的存在与回结肠动脉的交叉模式相关（χ = 4.24， ）。上述区域（目标区域）淋巴结转移的概率为2.10%（3/143）。总之，右半结肠引流淋巴管从前/后穿过SMV，到达中结肠动脉（MCA）水平附近的SMA表面，这突出了在淋巴结切除时我们目标区域切除肠系膜组织的潜在必要性。
