Lateral lymph node dissection in rectal cancer patients: is there any indication?
Lateral lymph node dissection in rectal cancer patients: is there any indication?
复制标题
直肠癌患者的侧方淋巴结清扫术：有什么指征吗？
DOI：
10.1007/s00384-003-0549-1
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发表时间：
2004
影响因子：
2.8
通讯作者：
B. Mann
中科院分区：
文献类型：
--
作者：
B. Mann
中低位直肠癌的最佳治疗方案是完善的全肠系膜切除（TME）和诊断为周围器官浸润（T4）的术前长期放化疗。在西方世界，讨论的焦点集中在距离盆腔脏器筋膜小于5mm的晚期T3癌是否应进行新辅助放化疗，如T4肿瘤，以及哪些患者从短期新辅助放疗或辅助放化疗中获益。几十年来，大多数日本外科医生都提倡沿髂总动脉和髂内动脉进行侧淋巴结清扫，特别是在晚期腹膜外直肠癌患者中。Koda等人在《国际结直肠疾病杂志》上发表了1984年至2000年间452例中低位直肠癌手术患者的资料：265例接受侧淋巴结清扫，155例长期新辅助放化疗。他们在7.7%的患者中发现外侧淋巴结转移，范围从0%(0/44)pT2中直肠肿瘤到18.8%(3/16)pT4下直肠肿瘤。在引入TME之前，单纯侧淋巴结清扫并不能提高生存率。新辅助放化疗与外侧淋巴联合
It is accepted that optimal therapy for middle and low rectal cancer should consist of a perfect total mesorectal excision (TME) and preoperative long-term radio-chemotherapy when infiltration of surrounding organs (T4) is diagnosed. In the Western world the discussion focus on the questions of whether advanced T3 carcinomas less than 5 mm from the fascia pelvica visceralis should undergo neoadjuvant radio-chemotherapy such as T4 tumors, and which patients would benefit from shortterm neoadjuvant radiation or from adjuvant radio-chemotherapy. For several decades mostly Japanese surgeons have promoted lateral lymph node dissection along the common and internal iliac artery particularly in patients with advanced extraperitoneal rectal carcinoma. In the International Journal of ColorectalDisease Koda et al.[1] present data from 452 patients with middle and low rectal cancer operated on between 1984 and 2000: 265 undergoing lateral lymph node dissection and 155 long-term neoadjuvant radiochemotherapy. They found lateral lymph node metastases in 7.7% of their patients, ranging from 0%(0/44) pT2 middle rectum tumors to 18.8%(3/16) pT4 lower rectum carcinomas. Prior to the introduction of TME lateral lymph node dissection alone did not improve survival rates. The combination of neoadjuvant radiochemotherapy with lateral lymph