Tsumura N, Sakuragi N, Hareyama H, Nomura E, Ohkouchi T, Yamamoto R, Takeda N, Nishiya M, Hirahatake K, Fujino T, Okubo H, Satoh C, Makinoda S, Kawaguchi I, Fujimoto S
Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo.
Nihon Sanka Fujinka Gakkai Zasshi. 1996 Jul;48(7):508-14.
We performed a systematic retroperitoneal lymph node dissection (RPLND) on 137 patients with primary ovarian carcinoma, of whom 97 had undergone RPLND during the primary surgery before chemotherapy and 40 had undergone RPLND during the secondary cytoreductive surgery after preoperative chemotherapy. The tentative staging of the ovarian carcinoma used in this study was determined according to the FIGO criteria without considering the pathologic findings of retroperitoneal lymph nodes. Nodal metastasis was seen in 21.9% (30/137) of them. Thirteen had positive pelvic lymph nodes (PLN) but no positive para-aortic nodes (PAN). Eleven had both positive PLN and positive PAN. Six had positive PAN but no positive PLN. The PAN was the most frequent site of metastasis (17/137). Next were the common iliac, obturator, and lateral group of deep inguinal nodes. Solitary metastasis in the patients who had undergone RPLND during the primary surgery was seen in a PAN and a common iliac node. Among 24 patients with PLN metastasis, there was a significant (p < 0.05) difference in the number of positive PLN between the patients with PAN metastasis (5.27 +/- 3.00) and the patients without PAN metastasis (2.62 +/- 1.66). These results indicate that the PAN and common iliac nodes are the most important site of nodal metastasis in ovarian carcinoma. The metastasis to PLN such as obturator node and internal iliac node seems to occur independently of the PAN metastasis, and the PAN metastasis occurs not only through the direct route but also as a consequence of extension of PLN metastases. Systematic retroperitoneal lymph node exploration therefore seems to be necessary to clarify the lymph node status.
我们对137例原发性卵巢癌患者进行了系统性腹膜后淋巴结清扫术（RPLND），其中97例在化疗前的初次手术中接受了RPLND，40例在术前化疗后的二次细胞减灭术中接受了RPLND。本研究中使用的卵巢癌初步分期是根据国际妇产科联盟（FIGO）标准确定的，未考虑腹膜后淋巴结的病理结果。其中21.9%（30/137）出现淋巴结转移。13例盆腔淋巴结（PLN）阳性但腹主动脉旁淋巴结（PAN）无转移。11例PLN和PAN均阳性。6例PAN阳性但PLN无转移。PAN是最常见的转移部位（17/137）。其次是髂总、闭孔和腹股沟深淋巴结外侧组。在初次手术中接受RPLND的患者中，孤立转移见于一个PAN和一个髂总淋巴结。在24例PLN转移患者中，有PAN转移的患者（5.27±3.00）与无PAN转移的患者（2.62±1.66）之间，PLN阳性数量存在显著差异（p<0.05）。这些结果表明，PAN和髂总淋巴结是卵巢癌淋巴结转移的最重要部位。向闭孔淋巴结和髂内淋巴结等PLN的转移似乎独立于PAN转移发生，而PAN转移不仅通过直接途径发生，也作为PLN转移扩展的结果发生。因此，系统性腹膜后淋巴结探查似乎对于明确淋巴结状态是必要的。
