Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T
First Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto 602, Japan.
World J Surg. 1997 Jan;21(1):109-15. doi: 10.1007/s002689900202.
To determine the indications for limited colon cancer surgery in each location, we reviewed the arterial branching patterns and lymph node metastases along the course of specific vascular trunks in 344 colon cancer patients who had undergone preoperative angiography and colectomy with lymph node dissection. Our conclusions are follows: Because the ileocecal artery always arises from the superior mesenteric artery and lymph node metastases of cecum cancer were limited to nodes along the ileocolic artery, cecum cancer can be cured by ileocecal resection. The right colic artery has various origins, and ascending colon cancer shows various patterns of lymph node metastases. Therefore a right hemicolectomy should be performed for ascending colon cancer. The middle colic artery forks into right and left branches, and each branch has different branching variations. If the right colic and middle colic arteries have a common trunk, a right hemicolectomy should be performed for transverse colon cancer on the right side. If the left branch of the middle colic artery has an independent replaced origin, lymph node dissection should be modified according to the variant origin. If the left colic artery and the first sigmoidal artery have a common trunk, the lymph nodes along the common trunk should be removed for sigmoid colon cancer and for descending colon cancer. Of the patients with sigmoid colon cancer, 6.3% also had lymph node metastases along the superior rectal artery. Given that the lymph nodes along the superior rectal artery are skeletonized, sigmoid colon cancer can be also cured by partial sigmoidectomy.
为确定各部位局限性结肠癌手术的适应证，我们回顾了344例接受术前血管造影及结肠癌根治术加淋巴结清扫术的结肠癌患者特定血管主干走行沿途的动脉分支模式及淋巴结转移情况。我们得出以下结论：由于回结肠动脉总是发自肠系膜上动脉，且盲肠癌的淋巴结转移局限于沿回结肠动脉分布的淋巴结，因此盲肠癌可行回盲部切除术治愈。右结肠动脉起源多样，升结肠癌的淋巴结转移模式也各不相同。因此，升结肠癌应行右半结肠切除术。中结肠动脉分为左右两支，且各分支有不同的分支变异。如果右结肠动脉和中结肠动脉有共同主干，右侧横结肠癌应行右半结肠切除术。如果中结肠动脉左支有独立的替代起源，应根据变异起源调整淋巴结清扫范围。如果左结肠动脉和第一乙状结肠动脉有共同主干，乙状结肠癌和降结肠癌应切除沿共同主干分布的淋巴结。在乙状结肠癌患者中，6.3%的患者还存在沿直肠上动脉的淋巴结转移。鉴于沿直肠上动脉的淋巴结已被彻底清扫，乙状结肠癌也可行部分乙状结肠切除术治愈。
