Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K
First Department of Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
Cancer. 1997 Jul 15;80(2):188-92.
The surgeon is no longer able to palpate the mesocolon for lymph node metastases during laparoscopic colectomy. The extent of lymph node dissection should be determined beforehand for cancer control.
The distribution of lymph node metastases was obtained by the clearing method on colon carcinomas for 164 patients.
For pericolic spread: for pT1 tumors, the distance from the primary tumor to a metastatic lymph node was 2.5 cm; for pT2, the distance was within 5 cm; for 97.0 % of pT3 tumors with lymph node metastases, the distance was within 7 cm; for 93.3 % of pT4 tumors with lymph node metastases, the distance was within 7 cm. For central spread: for pT1 tumors, the rate of metastasis to central lymph nodes was 0 %; for pT2, the rate of metastasis was 20.0 % to intermediate lymph nodes; for pT3, the rate of metastasis was 30.6 % to intermediate lymph nodes and 15.3 % to main lymph nodes; for pT4, the rate of metastasis was 44.4 % to intermediate lymph nodes and 22.2 % to main lymph nodes.
Central lymph node dissection is not required for patients with T1 carcinomas, but proximal and distal 3-cm margins of resection are required. For T2, central lymph node dissection that includes the intermediate lymph node should be performed, as well as 5-cm proximal and distal margins of resection. For T3 and T4, central lymph node dissection including the main lymph node should be performed, as well as 7-cm proximal and distal margins of resection. [See editorial on pages 177-8, this issue.]
在腹腔镜结肠切除术期间，外科医生无法触诊结肠系膜以检查淋巴结转移情况。为了控制癌症，应预先确定淋巴结清扫的范围。
通过对164例结肠癌患者采用清扫法获取淋巴结转移的分布情况。
对于结肠周围扩散：对于pT1肿瘤，原发肿瘤至转移淋巴结的距离为2.5 cm；对于pT2，距离在5 cm以内；对于97.0%有淋巴结转移的pT3肿瘤，距离在7 cm以内；对于93.3%有淋巴结转移的pT4肿瘤，距离在7 cm以内。对于中央扩散：对于pT1肿瘤，中央淋巴结转移率为0%；对于pT2，转移至中间淋巴结的比率为20.0%；对于pT3，转移至中间淋巴结的比率为30.6%，转移至主要淋巴结的比率为15.3%；对于pT4，转移至中间淋巴结的比率为44.4%，转移至主要淋巴结的比率为22.2%。
T1期癌患者无需进行中央淋巴结清扫，但需要切除近端和远端3 cm切缘。对于T2期，应进行包括中间淋巴结的中央淋巴结清扫，以及近端和远端5 cm切缘的切除。对于T3和T4期，应进行包括主要淋巴结的中央淋巴结清扫，以及近端和远端7 cm切缘的切除。[见本期第177 - 178页的社论。]
