Department of Gastrointestinal Surgery, Quanzhou First Hospital affiliated to Fujian Medical University, No. 248 Dong Street, Licheng District, Quanzhou, 362000, Fujian, China.
Department of Colorectal Surgery, the First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
World J Surg Oncol. 2021 Oct 22;19(1):310. doi: 10.1186/s12957-021-02414-z.
D3 or complete mesocolic excision (CME) surgery has become a common surgical procedure for the treatment of colon cancer metastasis. Clinical misuse and overuse of lymph node dissection bring unnecessary burdens to patients. A detailed guidance for lymph node dissection in patients with T3 and T4 stage right colon cancer at different locations is urgently needed.
A retrospective study was performed. Patients received D3 or CME surgery were divided into ileocecal group, ascending colon group, and hepatic flexure group according to the 9th edition of the Japanese Society for Cancer of the Colon and Rectum guidelines. The distributions of lymph node metastases were analyzed according to tumor infiltration depth (T stage) and tumor location.
The incidence of metastases in the paracolic area (or station), intermediate area, and main (or central) area was 38.4% (139/362), 12.7% (46/362), and 9.7% (35/362), respectively. The proportion of patients having No.206 and terminal ileum lymph nodes metastases was 7.7% (14/181) and 3.7% (9/244), respectively. No.206 lymph node metastasis is related to tumor location (χ = 7.955, p = 0.019) and degree of differentiation (χ = 18.99, p = 0.000), and terminal ileum lymph node metastasis is related to tumor location (χ = 6.273, p = 0.043). Patients with T3/T4 hepatic flexure cancer received radical right hemicolectomy in addition to No.206 lymph node dissection.
Radical right hemicolectomy and No.206 group lymph node dissection are necessary for T3 and T4 stage colon cancer therapy.
D3 或完整结肠系膜切除术（CME）已成为治疗结肠癌转移的常见手术方法。临床对淋巴结清扫术的不当和过度使用给患者带来了不必要的负担。急需为不同部位 T3 和 T4 期右半结肠癌患者提供详细的淋巴结清扫指导。
进行了一项回顾性研究。根据日本结直肠癌协会第 9 版指南，将接受 D3 或 CME 手术的患者分为回盲部组、升结肠组和肝曲组。根据肿瘤浸润深度（T 分期）和肿瘤位置分析淋巴结转移的分布。
结肠旁区（或站）、中间区和主（或中央）区转移的发生率分别为 38.4%（139/362）、12.7%（46/362）和 9.7%（35/362）。No.206 和回肠末端淋巴结转移的患者比例分别为 7.7%（14/181）和 3.7%（9/244）。No.206 淋巴结转移与肿瘤位置（χ²=7.955，p=0.019）和分化程度（χ²=18.99，p=0.000）有关，回肠末端淋巴结转移与肿瘤位置有关（χ²=6.273，p=0.043）。T3/T4 肝曲癌患者除了清扫 No.206 淋巴结外，还需行根治性右半结肠切除术。
对于 T3 和 T4 期结肠癌，根治性右半结肠切除术和 No.206 组淋巴结清扫是必要的。
