Optimal Size Criteria for Lateral Lymph Node Dissection After Neoadjuvant Chemoradiotherapy for Rectal Cancer
Optimal Size Criteria for Lateral Lymph Node Dissection After Neoadjuvant Chemoradiotherapy for Rectal Cancer
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DOI：
10.1097/dcr.0000000000001866
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发表时间：
2021-03-01
影响因子：
3.9
通讯作者：
Ishihara, Soichiro
中科院分区：
文献类型：
--
作者：
Kawai, Kazushige;Shiratori, Hiroshi;Ishihara, Soichiro
背景技术背景：虽然放化疗后行根治性手术而不进行侧方淋巴结清扫是目前直肠癌患者的标准治疗方法，但最近的研究表明，在疑似侧方淋巴结转移的患者中，在全直肠系膜切除术的基础上增加侧方淋巴结清扫的益处。然而，最佳适应症的侧方淋巴结清扫化疗后放射治疗尚未确定。目的：本研究旨在确定直肠癌患者放化疗后侧方淋巴结清扫的最佳适应证。设计：回顾性研究。设置：本研究在一家转诊医院进行。病人：回顾性入组了2007年至2018年期间接受放化疗后接受根治性手术的279例直肠癌患者。主要观察指标：回顾性评估CT上最大的外侧淋巴结，并与外侧淋巴结清扫和外侧淋巴结复发的病理结果进行比较。结果：放化疗后侧方淋巴结转移率为9.3%。虽然有侧方淋巴结转移的患者经常发生远处复发，但40.4%的患者存活>5年而无复发。对侧位淋巴结大小的分析表明，放化疗前侧位淋巴结大小≥ 8mm是侧位淋巴结清扫的最佳标准，其敏感性和特异性分别为92.3%和78.7%。按此标准，72.0%的患者可免于侧方淋巴结清扫。限制条件：由于本研究的回顾性性质，选择接受外侧淋巴结清扫术的患者存在偏见。结论：侧淋巴结清扫的最佳适应证是放化疗前侧淋巴结大小≥ 8 mm。对于>30%的侧方淋巴结转移患者，通过清扫转移的侧方淋巴结，可使肿瘤完全根除。参见http://links.lww.com/DCR/B428上的视频摘要。
BACKGROUND: Although chemoradiotherapy followed by radical surgery without lateral lymph node dissection is the current standard treatment in patients with rectal cancer, recent studies have demonstrated the benefits of adding lateral lymph node dissection to total mesorectal excision in patients with suspected lateral lymph node metastasis. However, the optimal indication for lateral lymph node dissection after chemoradiotherapy has not been determined. OBJECTIVE: This study aimed to establish the optimal indication for lateral lymph node dissection after chemoradiotherapy in patients with rectal cancer. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single referral hospital. PATIENTS: A total of 279 patients with rectal cancer who underwent chemoradiotherapy followed by radical surgery between 2007 and 2018 were retrospectively enrolled. MAIN OUTCOME MEASURES: The largest lateral lymph nodes on CT were retrospectively assessed and compared with the pathologic results of dissected lateral lymph nodes and recurrences in lateral lymph node areas. RESULTS: The incidence of lateral lymph node metastasis after chemoradiotherapy was estimated to be 9.3%. Although patients with lateral lymph node metastasis frequently developed distant recurrence, 40.4% survived for >5 years without recurrence. An analysis of the lateral lymph node sizes showed that lateral lymph node size =8 mm before chemoradiotherapy was the optimal criterion for lateral lymph node dissection, with a sensitivity and specificity of 92.3% and 78.7%. Using this criterion, 72.0% of the patients could be spared lateral lymph node dissection. LIMITATIONS: Because of the retrospective nature of the present study, the selection of patients who underwent lateral lymph node dissection was biased. CONCLUSIONS: The optimal indication for lateral lymph node dissection was lateral lymph node size =8 mm before chemoradiotherapy. Cancer could be eradicated in >30% of patients with lateral lymph node metastasis by dissecting metastatic lateral lymph nodes. See Video Abstract at http://links.lww.com/DCR/B428.