Koga Fumiki, Fujita Fumihiko, Yoshida Takefumi, Koushi Kenichi, Yoshida Naohiro, Shigaki Takahiro, Fujiyoshi Kenji, Mori Naoki, Sudou Tomoya, Akiba Jun, Ishibashi Nobuya, Hisaka Touru
Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):316-322. doi: 10.23922/jarc.2024-007. eCollection 2024.
In advanced left-sided colorectal cancer, cutting the root of the inferior mesenteric artery (IMA) branching from the aorta is recommended for complete lymph node dissection. However, this procedure sometimes causes severe complications. This study aimed to elucidate the lymph nodes' distribution around the IMA and identify the most critical sites for lymph node dissection.
This study included 30 consecutive patients with left-sided colorectal cancer who underwent curative resection with main lymph node dissection in a single institution between January and June of 2022. The mesenteric sections (main lymph nodes, IMA, left colic artery [LCA], and inferior mesenteric vein) were removed from the surgically excised specimen. Subsequently, whole-tissue sections were prepared and stained with hematoxylin and eosin. The positional relationships between each blood vessel and respective lymph nodes were then assessed using the pathological findings.
The main lymph nodes were identified in 26 out of 30 patients. The total number of dissected lymph nodes per patient was 0-30 (average: 5.3), and the median distance from the IMA to the main lymph node was 7.61 mm (1.87-43.26 mm). Dividing the lymph nodes into segments, we found 18%, 46%, and 36% of the lymph nodes in the proximal, middle, and distal segments, respectively. Additionally, all lymph nodes were found outside of the IMA sheath surrounding each arterial wall.
In left-sided colorectal cancer, the main lymph nodes are mostly located around the LCA bifurcation, which may be essential to ensure main lymph node dissection for advanced stage cases.
在晚期左侧结直肠癌中，建议切断从主动脉分支的肠系膜下动脉（IMA）根部以进行完整的淋巴结清扫。然而，该手术有时会导致严重并发症。本研究旨在阐明IMA周围淋巴结的分布，并确定淋巴结清扫的最关键部位。
本研究纳入了2022年1月至6月期间在单一机构接受根治性切除并进行主要淋巴结清扫的30例连续性左侧结直肠癌患者。从手术切除的标本中取出肠系膜部分（主要淋巴结、IMA、左结肠动脉[LCA]和肠系膜下静脉）。随后，制备全组织切片并用苏木精和伊红染色。然后利用病理结果评估各血管与相应淋巴结之间的位置关系。
30例患者中有26例发现了主要淋巴结。每位患者清扫的淋巴结总数为0 - 30个（平均：5.3个），从IMA到主要淋巴结的中位距离为7.61 mm（1.87 - 43.26 mm）。将淋巴结分为几段，我们发现近端、中段和远端段的淋巴结分别占18%、46%和36%。此外，所有淋巴结均位于围绕各动脉壁的IMA鞘外。
在左侧结直肠癌中，主要淋巴结大多位于LCA分叉周围，这对于确保晚期病例的主要淋巴结清扫可能至关重要。
