Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-Ku, Tokyo, 113-8510, Japan.
Int J Clin Oncol. 2022 Nov;27(11):1717-1724. doi: 10.1007/s10147-022-02236-3. Epub 2022 Aug 27.
According to Japanese guidelines, D2 or D3 lymph node dissection (LND) is indicated for cT2N0M0 colorectal cancer (CRC). In this study, we retrospectively compared the long-term outcomes between D2 and D3 LND among patients with cT2N0M0 CRC.
Our sample included 515 patients from the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer database, who underwent surgical resection for cT2N0M0 CRC between January 2009 and December 2012, 195 (37.9%) of whom underwent D2 LND and 320 (62.1%) D3 LND. The D2 and D3 groups were retrospectively compared in terms of long-term outcomes including overall survival (OS) and relapse-free survival (RFS). The prognostic factors for these outcomes were also evaluated.
The D2 group had significantly older patients and higher proportion of men than the D3 group. The rates of OS (5-year OS; 94.8% in the D3 group vs. 93.4% in the D2 group, p = 0.38) and RFS (5-year RFS; 89.3% in the D3 group vs. 89.1% in the D2 group, p = 0.91) were comparable for both groups. On multivariate analysis, age ≥ 80 years was significantly associated with poor OS. The extent of LND was not associated with either OS or RFS. Long-term outcomes were similar between the two groups, independent of tumor location.
The long-term outcomes did not differ between the D2 and D3 groups and the extent of LND was not associated with prognosis for cT2N0M0 CRC. Therefore, D2 LND may be sufficient for cT2N0N0 CRC treatment.
根据日本指南，对于 cT2N0M0 结直肠癌（CRC），建议进行 D2 或 D3 淋巴结清扫术（LND）。本研究回顾性比较了 cT2N0M0 CRC 患者中 D2 和 D3 LND 的长期结果。
我们的样本包括来自日本结直肠癌术后随访数据库的 515 名接受 cT2N0M0 CRC 手术切除的患者，他们于 2009 年 1 月至 2012 年 12 月期间接受手术治疗，其中 195 名（37.9%）接受了 D2 LND，320 名（62.1%）接受了 D3 LND。回顾性比较 D2 和 D3 组的长期结果，包括总生存（OS）和无复发生存（RFS）。还评估了这些结果的预后因素。
D2 组患者年龄明显大于 D3 组，且男性比例较高。两组患者的 OS 率（5 年 OS；D3 组为 94.8%，D2 组为 93.4%，p=0.38）和 RFS 率（5 年 RFS；D3 组为 89.3%，D2 组为 89.1%，p=0.91）相当。多因素分析显示，年龄≥80 岁与 OS 不良显著相关。LND 的范围与 OS 或 RFS 均无关。两组的长期结果相似，与肿瘤位置无关。
D2 和 D3 组之间的长期结果没有差异，LND 的范围与 cT2N0M0 CRC 的预后无关。因此，D2 LND 可能足以治疗 cT2N0M0 CRC。
