Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-0021, Japan.
Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Int J Colorectal Dis. 2024 May 28;39(1):80. doi: 10.1007/s00384-024-04650-7.
Although lateral lymph node dissection has been performed to prevent lateral pelvic recurrence in locally advanced lower rectal cancer, the incidence of lateral pelvic recurrence after this procedure has not been investigated. Therefore, this study aimed to investigate the long-term outcomes of patients who underwent lateral pelvic lymph node dissection, with a particular focus on recurrence patterns.
This was a retrospective study conducted at a single high-volume cancer center in Japan. A total of 493 consecutive patients with stage II-III rectal cancer who underwent lateral lymph node dissection between January 2005 and August 2022 were included. The primary outcome measures included patterns of recurrence, overall survival, and relapse-free survival. Patterns of recurrence were categorized as lateral or central pelvic.
Among patients who underwent lateral lymph node dissection, 18.1% had pathologically positive lateral lymph node metastasis. Lateral pelvic recurrence occurred in 5.5% of patients after surgery. Multivariate analysis identified age > 75 years, lateral lymph node metastasis, and adjuvant chemotherapy as independent risk factors for lateral pelvic recurrence. Evaluation of the recurrence rate by dissection area revealed approximately 1% of recurrences in each area after dissection.
We demonstrated the prognostic outcome and limitations of lateral lymph node dissection for patients with advanced lower rectal cancer, focusing on the incidence of recurrence in the lateral area after the dissection. Our study emphasizes the clinical importance of lateral lymph node dissection, which is an essential technique that surgeons should acquire.
尽管在局部晚期低位直肠癌中进行了侧方淋巴结清扫术以预防侧方盆部复发，但该术式后侧方盆部复发的发生率尚未得到研究。因此，本研究旨在探讨接受侧方盆部淋巴结清扫术患者的长期结果，特别关注复发模式。
这是在日本一家高容量癌症中心进行的回顾性研究。共纳入 493 例接受侧方淋巴结清扫术的 II-III 期直肠癌患者，手术时间为 2005 年 1 月至 2022 年 8 月。主要观察终点包括复发模式、总生存和无复发生存。复发模式分为侧方或中央盆部。
接受侧方淋巴结清扫术的患者中，有 18.1%的患者存在侧方淋巴结转移的病理学阳性。术后有 5.5%的患者发生侧方盆部复发。多因素分析显示，年龄＞75 岁、侧方淋巴结转移和辅助化疗是侧方盆部复发的独立危险因素。根据解剖区域评估复发率，发现解剖后每个区域的复发率约为 1%。
我们展示了晚期低位直肠癌患者接受侧方淋巴结清扫术的预后结果和局限性，重点关注了术后侧方区域的复发发生率。本研究强调了侧方淋巴结清扫术的临床重要性，这是外科医生应该掌握的一项重要技术。
