Ouchi Akira, Komori Koji, Kinoshita Takashi, Sato Yusuke, Malakorn Songphol, Manomayangoon Chatiyaporn, Ito Seiji, Abe Tetsuya, Shimizu Yasuhiro
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Anus Rectum Colon. 2024 Oct 25;8(4):356-364. doi: 10.23922/jarc.2024-049. eCollection 2024.
To investigate the significance of lateral pelvic lymph node dissection (LPLND) in resectable stage IV low rectal cancers, reviewing the treatment outcomes from a single cancer center dedicated to LPLND.
Consecutive 56 patients with stage IV low rectal cancers who underwent primary tumor resection (PTR) between 2007 and 2022 were identified. Sixteen patients with non-curative PTR were excluded, and 40 with curative PTR were analyzed.
The dominant metastatic organ was the liver in 30 (75.0%) patients, followed by the lung in 9 (22.5%). Seven (17.5%) patients had multiple organ metastasis. Five of 40 patients had cT1bN0 or cT2N0 disease, 8 did not receive LPLND for other reasons, and accordingly, 27 (67.5%) finally received LPLND. A total of 15 patients (37.5% of all 40 cases and 55.5% of 27 LPLND cases) had LPLN metastasis. Six (15.0%) patients had bilateral metastasis, and 6 (15.0%) had LD3 metastasis. Eight (20.0%) patients developed local recurrence (LR), and the 5Y-LR rate was 22.3%. Twelve (30.0%) patients underwent preceding chemotherapy before PTR, 26 (65.0%) received chemotherapy after PTR, and 23 (57.5%) achieved complete resection. Twelve (52.2%) of 23 patients developed distant recurrence after complete resection. 5Y-overall survival for all patients was 42.4%.
A high rate of LPLN metastasis implies the significance of management for LPLN metastasis; meanwhile, an unsatisfactory complete resection rate and overall survival implies that LPLN metastasis in this cohort should be dealt with as a systemic disease.
探讨侧方盆腔淋巴结清扫术（LPLND）在可切除的IV期低位直肠癌中的意义，回顾一个专门进行LPLND的癌症中心的治疗结果。
确定了2007年至2022年间连续56例接受原发性肿瘤切除术（PTR）的IV期低位直肠癌患者。排除16例非根治性PTR患者，分析40例根治性PTR患者。
30例（75.0%）患者的主要转移器官为肝脏，其次是9例（22.5%）肺部。7例（17.5%）患者有多个器官转移。40例患者中有5例为cT1bN0或cT2N0疾病，8例因其他原因未接受LPLND，因此，27例（67.5%）最终接受了LPLND。共有15例患者（占所有40例的37.5%，27例LPLND病例的55.5%）发生侧方盆腔淋巴结转移。6例（15.0%）患者有双侧转移，6例（15.0%）有LD3转移。8例（20.0%）患者发生局部复发（LR），5年LR率为22.3%。12例（30.0%）患者在PTR前接受了化疗，26例（65.0%）在PTR后接受了化疗，23例（57.5%）实现了完全切除。23例患者中有12例（52.2%）在完全切除后发生远处复发。所有患者的5年总生存率为42.4%。
侧方盆腔淋巴结转移率高意味着对侧方盆腔淋巴结转移进行处理的重要性；同时，完全切除率和总生存率不理想意味着该队列中的侧方盆腔淋巴结转移应作为一种全身性疾病来处理。
