Hida J, Yasutomi M, Fujimoto K, Ieda S, Machidera N, Kubo R, Shindo K
First Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
Dis Colon Rectum. 1996 Nov;39(11):1282-5. doi: 10.1007/BF02055123.
It has been reported that functional outcome following low anterior resection of resection of rectal cancer is improved by construction of a colonic J-pouch compared with straight anastomosis. Hence, we tried to justify use of the sigmoid colon in the construction of a J-pouch by the analysis of regional lymph node metastases.
A total of 182 patients underwent resection for rectal cancer. Node metastases were examined by the clearing method. According to Japanese General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus (JGR), nodes were classified into the perirectal nodes (PR-N), pericolic nodes (PC-N), central intermediate nodes (C-IM-N), central main nodes (C-M-N), lateral intermediate nodes (L-IM-N), and lateral main nodes (L-M-N).
Metastatic rate (number of patients with node metastases/total number of patients) of PR-N was 57.1 percent. Metastatic rate of C-IM-N was 18.7 percent and that of C-M-N was 7.1 percent. Metastatic rates of L-IM-N and L-M-N were 8.8 and 3.3 percent, respectively, and both were highest in the case of lower rectal cancer. Metastatic rate of PC-N was only 1.1 percent. The number of cases without node metastases (n(-) cases) was 78, that with only PR-N metastases (PR-N cases) was 63, that with intermediate but not main node metastases (IM-N cases) was 29, and that with main node metastases (M-N cases) was 12. Five-year survival rate after curative resection was 88.5 percent for n(-) cases, 70.9 percent for PR-N cases, 65.9 percent for IM-N cases, and 41.7 percent for M-N cases.
In low anterior resection, high ligation of the inferior mesenteric artery and dissection of C-M-N, C-IM-N and PR-N are necessary, with the addition of the L-IM-N and L-M-N in the case of lower rectal cancer. Resection of sigmoid colon is not required, and therefore, a J-pouch can be constructed using the sigmoid colon. Nodal classification according to the JGR was predictive of case distribution and five-year survival rate.
据报道，与直接吻合相比，直肠癌低位前切除术后通过构建结肠J形贮袋可改善功能结局。因此，我们试图通过分析区域淋巴结转移情况来证明在构建J形贮袋时使用乙状结肠的合理性。
共有182例患者接受了直肠癌切除术。通过清扫法检查淋巴结转移情况。根据日本结直肠癌和肛管癌临床与病理研究通用规则（JGR），淋巴结分为直肠旁淋巴结（PR-N）、结肠旁淋巴结（PC-N）、中央中间淋巴结（C-IM-N）、中央主淋巴结（C-M-N）、外侧中间淋巴结（L-IM-N）和外侧主淋巴结（L-M-N）。
PR-N的转移率（有淋巴结转移的患者数/患者总数）为57.1%。C-IM-N的转移率为18.7%，C-M-N的转移率为7.1%。L-IM-N和L-M-N的转移率分别为8.8%和3.3%，且均在低位直肠癌病例中最高。PC-N的转移率仅为1.1%。无淋巴结转移的病例数（n(-)病例）为78例，仅有PR-N转移的病例（PR-N病例）为63例，有中间但无主淋巴结转移的病例（IM-N病例）为29例，有主淋巴结转移的病例（M-N病例）为12例。根治性切除术后n(-)病例的5年生存率为88.5%，PR-N病例为70.9%，IM-N病例为65.9%，M-N病例为41.7%。
在低位前切除术中，肠系膜下动脉高位结扎及C-M-N、C-IM-N和PR-N的清扫是必要的，低位直肠癌病例还需加做L-IM-N和L-M-N的清扫。无需切除乙状结肠，因此，可以使用乙状结肠构建J形贮袋。根据JGR进行的淋巴结分类可预测病例分布和5年生存率。
