Toyota S, Ohta H, Anazawa S
Department of Surgery, Cancer Institute Hospital, Jikei University School of Medicine, Tokyo, Japan.
Dis Colon Rectum. 1995 Jul;38(7):705-11. doi: 10.1007/BF02048026.
The extent of lymph node dissection optimal for the prognosis of right colon cancer is investigated.
Between 1946 and 1991, 275 patients had curative operation for right colon cancer. A retrospective analysis of rate and degree of lymph node metastasis was performed in each of the 275 patients, and survival rate was estimated in 197 patients who could be followed over a period of three years or more.
In most of the curative operative cases of right colon cancer, metastasis to epicolic and paracolic nodes was restricted up to 10 cm proximal or distal to the tumor margin, and metastasis in the central direction was restricted up to main nodes. When cancer metastasized to infrapyloric lymph nodes, dissection of the nodes resulted in a higher rate of long-term prognosis. The five-year cumulative survival rates showed no statistically significant difference between any two of the N0 to N3 lymph node metastasis groups.
The dissection procedure for right colon cancer involved removal of 10 cm of normal bowel both proximal and distal to the lesion and, in the central direction, dissection of regional lymph nodes along the main trunk artery up to main nodes, i.e., nodes situated anterior to the surgical trunk, which was confirmed to have a therapeutically satisfactory benefit. Infrapyloric lymph nodes must be dissected when metastasis to the nodes is suspected. In cases of cecal or ascending colon cancer in which the middle colic artery is no longer the main trunk artery, a right hemicolectomy with resection of only the right branch of the middle colic artery will usually suffice.
研究对右半结肠癌预后最适宜的淋巴结清扫范围。
1946年至1991年间，275例患者接受了右半结肠癌根治性手术。对这275例患者中的每一例进行淋巴结转移率和转移程度的回顾性分析，并对197例能够随访三年或更长时间的患者进行生存率评估。
在大多数右半结肠癌根治性手术病例中，肿瘤边缘近端或远端10 cm范围内的肠旁和结肠旁淋巴结转移受到限制，向中央方向的转移仅限于主要淋巴结。当癌症转移至幽门下淋巴结时，清扫这些淋巴结可提高长期预后率。N0至N3淋巴结转移组中任意两组之间的五年累积生存率无统计学显著差异。
右半结肠癌的清扫程序包括切除病变近端和远端10 cm的正常肠段，在中央方向，沿主干动脉清扫区域淋巴结直至主要淋巴结，即位于手术主干前方的淋巴结，这已被证实具有令人满意的治疗效果。当怀疑幽门下淋巴结转移时，必须进行清扫。对于盲肠或升结肠癌，若中结肠动脉不再是主干动脉，通常仅切除中结肠动脉右支的右半结肠切除术就足够了。
