Song Bolun, Wang Liming, Chen Yinggang, Hirano Yasumitsu
Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
J Gastrointest Oncol. 2025 Apr 30;16(2):517-527. doi: 10.21037/jgo-2024-980. Epub 2025 Apr 27.
The extent of lymphadenectomy undertaken in patients with cT2N0 colorectal cancer (CRC) remains controversial. The aim of our study was to compare survival in such patients by level of lymph node dissection (LND) performed.
This retrospective cohort study was conducted at a high-volume cancer center in Japan. Eligible patients (n=524) submitted to radical resections for cT2N0 CRC between April 2007 and December 2020 were included. Subjects were subsequently stratified by nature of LND (D2 D3) and propensity score matched at 1:2 ratio. We then analyzed group rates of overall survival (OS) and relapse-free survival (RFS) before and after matching.
Before matching, the D3 ( D2) LND group experienced a shorter mean operative time, less intraoperative blood loss, fewer postoperative complications, and a briefer average hospital stay, showing significantly better OS (P=0.001) as well. The estimated hazard ratio (HR) was 2.0 [95% confidence interval (CI): 1.0-3.9; P=0.04]. After matching, a significant difference in OS (P=0.007) was still observed, with an estimated HR of 2.3 (95% CI: 1.0-5.1; P=0.044).
D3 LND improves perioperative outcomes and OS in patients with cT2N0 CRC. Accurate preoperative imaging diagnostics are critical for proper surgical management for cT2N0 CRC.
cT2N0期结直肠癌（CRC）患者的淋巴结清扫范围仍存在争议。我们研究的目的是比较此类患者根据淋巴结清扫（LND）水平的生存率。
这项回顾性队列研究在日本一家大型癌症中心进行。纳入2007年4月至2020年12月间因cT2N0 CRC接受根治性切除术的符合条件患者（n = 524）。随后根据LND性质（D2、D3）对受试者进行分层，并按1:2的比例进行倾向评分匹配。然后我们分析了匹配前后的总生存率（OS）和无复发生存率（RFS）分组率。
匹配前，D3（对比D2）LND组的平均手术时间更短、术中出血量更少、术后并发症更少且平均住院时间更短，OS也显著更好（P = 0.001）。估计风险比（HR）为2.0[95%置信区间（CI）：1.0 - 3.9；P = 0.04]。匹配后，仍观察到OS存在显著差异（P = 0.007），估计HR为2.3（95%CI：1.0 - 5.1；P = 0.044）。
D3 LND可改善cT2N0 CRC患者的围手术期结局和OS。准确的术前影像诊断对于cT2N0 CRC的恰当手术管理至关重要。
