Mroczkowski Paweł, Dziki Łukasz, Vosikova Tereza, Otto Ronny, Merecz-Sadowska Anna, Zajdel Radosław, Zajdel Karolina, Lippert Hans, Jannasch Olof
Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland.
Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany.
Cancers (Basel). 2023 Jun 30;15(13):3447. doi: 10.3390/cancers15133447.
Lymph node dissection is a crucial element of oncologic rectal surgery. Many guidelines regard the removal of at least 12 lymph nodes as the quality criterion in rectal cancer. However, this recommendation remains controversial. This study examines the factors influencing the lymph node yield and the validity of the 12-lymph node limit. Patients with rectal cancer who underwent low anterior resection or abdominoperineal amputation between 2000 and 2010 were analyzed. In total, 20,966 patients from 381 hospitals were included. Less than 12 lymph nodes were found in 20.53% of men and 19.31% of women ( = 0.03). The number of lymph nodes yielded increased significantly from 2000, 2005 and 2010 within the quality assurance program for all procedures. The univariate analysis indicated a significant ( < 0.001) correlation between lymph node yield and gender, age, pre-therapeutic T-stage, risk factors and neoadjuvant therapy. The multivariate analyses found T3 stage, female sex, the presence of at least one risk factor and neoadjuvant therapy to have a significant influence on yield. The probability of finding a positive lymph node was proportional to the number of examined nodes with no plateau. There is a proportional relationship between the number of examined lymph nodes and the probability of finding an infiltrated node. Optimal surgical technique and pathological evaluation of the specimen cannot be replaced by a numeric cut-off value.
淋巴结清扫是直肠癌肿瘤手术的关键环节。许多指南将至少切除12枚淋巴结视为直肠癌手术的质量标准。然而，这一建议仍存在争议。本研究探讨了影响淋巴结获取数量的因素以及12枚淋巴结下限的有效性。对2000年至2010年间接受低位前切除术或腹会阴联合切除术的直肠癌患者进行了分析。总共纳入了来自381家医院的20966例患者。20.53%的男性和19.31%的女性患者发现的淋巴结少于12枚（P = 0.03）。在所有手术的质量保证计划中，从2000年到2005年再到2010年，获取的淋巴结数量显著增加。单因素分析表明淋巴结获取数量与性别、年龄、治疗前T分期、危险因素和新辅助治疗之间存在显著相关性（P < 0.001）。多因素分析发现T3期、女性、至少存在一个危险因素和新辅助治疗对淋巴结获取数量有显著影响。发现阳性淋巴结的概率与检查的淋巴结数量成正比，不存在平台期。检查的淋巴结数量与发现浸润性淋巴结的概率之间存在比例关系。最佳手术技术和标本的病理评估不能被一个数值界限所取代。
