Sato Harunobu, Maeda Kotaro, Kinugasa Yusuke, Kagawa Hiroyasu, Tsukamoto Shunsuke, Takahashi Keiichi, Nozawa Hiroaki, Takii Yasumasa, Konishi Tsuyoshi, Akagi Yoshito, Suto Takeshi, Yamaguchi Shigeki, Ozawa Heita, Komori Koji, Ohue Masayuki, Hiro Junichiro, Shinji Seiichi, Minami Kazuhito, Shimizu Tomoharu, Sakamoto Kazuhiro, Uehara Kay, Takahashi Hiroshi, Sugihara Kenichi
Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.
Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
Colorectal Dis. 2022 Oct;24(10):1150-1163. doi: 10.1111/codi.16169. Epub 2022 May 26.
The surgical treatment of inguinal lymph node (ILN) metastases secondary to anorectal adenocarcinoma remains controversial. This study aimed to clarify the surgical treatment and management of ILN metastasis according to its classification.
This retrospective, multi-centre, observational study included patients with synchronous or metachronous ILN metastases who were diagnosed with rectal or anal canal adenocarcinoma between January 1997 and December 2011. Treatment outcomes were analysed according to recurrence and prognosis.
Among 1181 consecutively enrolled patients who received treatment for rectal or anal canal adenocarcinoma at 20 referral hospitals, 76 (6.4%) and 65 (5.5%) had synchronous and metachronous ILN metastases, respectively. Among 141 patients with ILN metastasis, differentiated carcinoma, solitary ILN metastasis and ILN dissection were identified as independent predictive factors associated with a favourable prognosis. No significant difference was found in the frequency of recurrence after ILN dissection between patients with synchronous (80.6%) or metachronous (81.0%) ILN metastases. Patients who underwent R0 resection of the primary tumour and ILN dissection had a 5-year survival rate of 41.3% after ILN dissection (34.1% and 53.1% for patients with synchronous and metachronous ILN metastases, respectively, P = 0.55).
The ILN can be appropriately classified as a regional lymph node in rectal and anal canal adenocarcinoma. Moreover, aggressive ILN dissection might be effective in improving the prognosis of low rectal and anal canal adenocarcinoma with ILN metastases; thus, prophylactic ILN dissection is unnecessary.
肛管直肠癌继发腹股沟淋巴结（ILN）转移的外科治疗仍存在争议。本研究旨在根据ILN转移的分类明确其外科治疗及处理方法。
这项回顾性、多中心、观察性研究纳入了1997年1月至2011年12月期间被诊断为直肠或肛管腺癌且伴有同步或异时性ILN转移的患者。根据复发情况和预后分析治疗结果。
在20家转诊医院接受直肠或肛管腺癌治疗的1181例连续入组患者中，分别有76例（6.4%）和65例（5.5%）发生同步和异时性ILN转移。在141例发生ILN转移的患者中，分化型癌、孤立性ILN转移和ILN清扫被确定为与良好预后相关的独立预测因素。同步（80.6%）或异时性（81.0%）ILN转移患者在ILN清扫后复发频率无显著差异。对原发肿瘤进行R0切除并进行ILN清扫的患者在ILN清扫后的5年生存率为41.3%（同步和异时性ILN转移患者分别为34.1%和53.1%，P = 0.55）。
在直肠和肛管腺癌中，ILN可被合理地归类为区域淋巴结。此外，积极的ILN清扫可能对改善伴有ILN转移的低位直肠癌和肛管腺癌的预后有效；因此，无需进行预防性ILN清扫。
