[结肠癌的D2和D3淋巴结清扫术]

[D2 and D3 lymph node dissection for colon cancer].

作者信息

Kit O I, Gevorkyan Yu A, Karachun A M, Soldatkina N V, Bondarenko O K, Kolesnikov V E

机构信息

National Medical Research Center of Oncology, Rostov-on-Don, Russia.

Petrov Research Institute of Oncology, St. Petersburg, Russia.

出版信息

Khirurgiia (Mosk). 2024(7):25-35. doi: 10.17116/hirurgia202407125.

DOI:10.17116/hirurgia202407125

PMID:39008695

Abstract

OBJECTIVE

To evaluate surgical and oncological results of standard and extended lymph node dissection (D2 and D3) in patients with colon cancer.

MATERIAL AND METHODS

We analyzed treatment outcomes in 74 patients with colon cancer stage T1-4aN0-2M0 who underwent right- and left-sided hemicolectomy, resection of sigmoid colon with standard and extended lymph node dissection (D2 and D3).

RESULTS

Surgical approach and level of D3 lymph node dissection did not increase intra- and postoperative morbidity. Laparoscopic interventions were followed by significantly lower intraoperative blood loss and earlier gas discharge. Metastatic lesion of apical lymph nodes was observed in 5 out of 36 patients who underwent D3 lymph node dissection (13.8%), and metastases in regional lymph nodes rN1-2 were found in all these patients. Overall 5-year survival was 86%. Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection.

CONCLUSION

D3 lymph node dissection is safe for colon cancer. Metastatic lesions of apical lymph nodes during D3 lymph node dissection were detected only in patients with lesions of regional lymph nodes (rN1-2). Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection.

摘要

目的

评估结肠癌患者行标准和扩大淋巴结清扫术（D2和D3）的手术及肿瘤学结果。

材料与方法

我们分析了74例T1 - 4aN0 - 2M0期结肠癌患者的治疗结果，这些患者接受了左右半结肠切除术、乙状结肠切除术，并进行了标准和扩大淋巴结清扫术（D2和D3）。

结果

D3淋巴结清扫的手术方式和范围并未增加术中和术后发病率。腹腔镜手术的术中失血量明显较少，且排气更早。在36例行D3淋巴结清扫术的患者中，有5例（13.8%）观察到顶端淋巴结转移，且所有这些患者均发现区域淋巴结rN1 - 2转移。总体5年生存率为86%。D2和D3淋巴结清扫术后的无病生存率和总体5年生存率相似。