Ueno Hideki, Hase Kazuo, Shiomi Akio, Shiozawa Manabu, Ito Masaaki, Sato Toshihiko, Hashiguchi Yojiro, Kusumi Takaya, Kinugasa Yusuke, Ike Hideyuki, Matsuda Kenji, Yamada Kazutaka, Komori Koji, Takahashi Keiichi, Kanemitsu Yukihide, Ozawa Heita, Ohue Masayuki, Masaki Tadahiko, Takii Yasumasa, Ishibe Atsushi, Watanabe Jun, Toiyama Yuji, Sonoda Hiromichi, Koda Keiji, Akagi Yoshito, Itabashi Michio, Nakamura Takahiro, Sugihara Kenichi
Department of Surgery, National Defense Medical College, Saitama, Japan.
Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Lancet Reg Health West Pac. 2023 Jan 18;33:100680. doi: 10.1016/j.lanwpc.2022.100680. eCollection 2023 Apr.
There are no standardised criteria for the 'regional' pericolic node in colon cancer, which represents a major cause of the international uncertainty regarding the optimal bowel resection margin. This study aimed to determine 'regional' pericolic nodes based on prospective lymph node (LN) mapping.
According to preplanned measurements of the bowel, the anatomical distributions of the feeding artery and LNs were determined in 2996 stages I-III colon cancer patients who underwent colectomy with resection margin >10 cm at 25 institutions in Japan.
The mean number of retrieved pericolic nodes was 20.9 (standard deviation, 10.8) per patient. In all patients except seven (0.2%), the primary feeding artery was distributed within 10 cm of the primary tumour. The metastatic pericolic node most distant from the primary tumour was within 3 cm in 837 patients, 3-5 cm in 130 patients, 5-7 cm in 39 patients and 7-10 cm in 34 patients. Only four patients (0.1%) had pericolic lymphatic spread beyond 10 cm; all of whom had T3/4 tumours accompanying extensive mesenteric lymphatic spread. The location of metastatic pericolic node did not differ by the feeding artery's distribution. Postoperatively, none of the 2996 patients developed recurrence in the remaining pericolic nodes.
The pericolic nodes designated as 'regional' were those located within 10 cm of the primary tumours, which should be fully considered when determining the bowel resection margin, even in the era of complete mesocolic excision.
Japanese Society for Cancer of the Colon and Rectum.
结肠癌中“区域”结肠旁淋巴结尚无标准化标准，这是国际上关于最佳肠切除切缘存在不确定性的主要原因。本研究旨在基于前瞻性淋巴结（LN）图谱确定“区域”结肠旁淋巴结。
根据预先规划的肠管测量，在日本25家机构对2996例I-III期结肠癌患者进行了结肠切除术，切缘>10 cm，确定了供血动脉和淋巴结的解剖分布。
每位患者回收的结肠旁淋巴结平均数量为20.9个（标准差，10.8个）。除7例（0.2%）外，所有患者的主要供血动脉均分布在原发肿瘤的10 cm范围内。837例患者中，距原发肿瘤最远的转移结肠旁淋巴结在3 cm以内，130例在3-5 cm，39例在5-7 cm，34例在7-10 cm。只有4例（0.1%）患者的结肠旁淋巴转移超过10 cm；所有这些患者均为T3/4肿瘤并伴有广泛的肠系膜淋巴转移。转移结肠旁淋巴结的位置与供血动脉的分布无关。术后，2996例患者中无一例在剩余的结肠旁淋巴结出现复发。
被指定为“区域”的结肠旁淋巴结是位于原发肿瘤10 cm范围内的淋巴结，即使在完整结肠系膜切除时代，在确定肠切除切缘时也应充分考虑这一点。
日本结直肠癌协会
