Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Anorectal, First Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, 130021, China.
Eur J Surg Oncol. 2024 Dec;50(12):108737. doi: 10.1016/j.ejso.2024.108737. Epub 2024 Oct 2.
Characteristics and prognoses of lateral lymph node (LLN) metastasis but not mesenteric lymph node (LN) metastasis are poorly understood. This study explored patterns of mesenteric and LLN metastases in rectal cancer patients.
This retrospective, multicentre study was conducted at three institutions and included patients who underwent total mesorectal excision (TME) with lateral lymph node dissection (LLND) for rectal cancer (n = 271).
Among the patients with LLN metastases, 210 patients (77.5 %) with clinical stage T3-4 disease and 157 patients (57.9 %) with clinical stage N1-N2 disease underwent TME as well as LLND. The prognoses of patients with metastasis confined to LLNs were significantly better than those of patients with both mesenteric and LLN metastases (3-year overall survival: 85.0 % vs. 51.0 %, p = 0.005; 3-year disease-free survival: 75.0 % vs. 26.5 %, p = 0.003) and were similar to those of patients with metastasis confined to mesenteric LNs (3-year overall survival: 85.0 % vs. 83.8 %, p = 0.607; 3-year disease-free survival 75.0 % vs. 68.8 %, p = 0.717). Patients with metastases confined to LLN had a lower proportion of poor histological types (20.0 % vs. 65.3 %, p = 0.002), lymphatic invasion (20.0 % vs. 59.2 %, p = 0.036) and number of LLN metastases (1.6 vs 2.7, p = 0.004), and all metastases were confined to the internal iliac or obturator region (100.0 % vs. 77.6 %, p = 0.008) compared to patients with both mesenteric and LLN metastasis.
Approximately a quarter of patients with rectal cancer have LLN metastases but no mesenteric LN metastases. These patients have favourable pathological features and prognoses and can be managed and treated for mesenteric LN metastasis.
侧方淋巴结（LLN）转移的特征和预后，但不是肠系膜淋巴结（LN）转移的特征和预后了解甚少。本研究探讨了直肠癌患者肠系膜和 LLN 转移的模式。
本回顾性多中心研究在三个机构进行，纳入了 271 例接受全直肠系膜切除术（TME）加侧方淋巴结清扫术（LLND）治疗的直肠癌患者。
在有 LLN 转移的患者中，210 例（77.5%）临床分期为 T3-4 期和 157 例（57.9%）临床分期为 N1-N2 期的患者接受了 TME 加 LLND。局限于 LLN 转移的患者的预后明显优于同时存在肠系膜和 LLN 转移的患者（3 年总生存率：85.0% vs. 51.0%，p=0.005；3 年无病生存率：75.0% vs. 26.5%，p=0.003），与局限于肠系膜 LN 转移的患者相似（3 年总生存率：85.0% vs. 83.8%，p=0.607；3 年无病生存率：75.0% vs. 68.8%，p=0.717）。局限于 LLN 转移的患者具有较低比例的不良组织学类型（20.0% vs. 65.3%，p=0.002）、淋巴管侵犯（20.0% vs. 59.2%，p=0.036）和 LLN 转移数量（1.6 枚 vs. 2.7 枚，p=0.004），且所有转移均局限于髂内或闭孔区（100.0% vs. 77.6%，p=0.008），与同时存在肠系膜和 LLN 转移的患者相比。
约四分之一的直肠癌患者有 LLN 转移，但无肠系膜 LN 转移。这些患者具有良好的病理特征和预后，可以对肠系膜 LN 转移进行管理和治疗。
