Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer
Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer
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DOI：
10.5306/wjco.v8.i5.412
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发表时间：
2017-10-10
影响因子：
2.8
通讯作者：
Wakai, Toshifumi
中科院分区：
文献类型：
--
作者：
Tamura, Hiroshi;Shimada, Yoshifumi;Wakai, Toshifumi
目的探讨预防性盆腔淋巴结清扫术(LPLND)分期治疗的临床意义。方法连续选择71例低位直肠癌患者。低位直肠癌患者行一期肿瘤切除术，入选71例无临床LPLN转移患者中的50例。患者有肝、肺、腹膜、腹主动脉旁LN等远处转移。临床LPLN转移定义为术前盆腔CT扫描最大直径大于或等于10 mm的LN。所有患者均行一期肿瘤切除，27例行全直肠系膜切除联合LPLND(LPLND组)，23例行TME(TME组)。LPLND组在行双侧LPLND的同时行一期肿瘤切除。50例患者中有20例获得原发灶和转移灶的R0切除。结果单因素分析显示，与TME组相比，LPLND组与TME组无显著差异(28.7%vs17.0%，P=0.523)；多因素分析显示，R0切除是一个独立的预后因素。在累积局部复发率方面，LPLND组与TME组相比差异无统计学意义(21.4%vs14.8%，P=0.833)。结论预防性LPLND对分期患者无肿瘤益处。低位直肠癌无临床LPLN转移。
AIMTo assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage. low rectal cancer.METHODSWe selected 71 consecutive stage. low rectal cancer patients who underwent primary tumor resection, and enrolled 50 of these 71 patients without clinical LPLN metastasis. The patients had distant metastasis such as liver, lung, peritoneum, and paraaortic LN. Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan. All patients underwent primary tumor resection, 27 patients underwent total mesorectal excision (TME) with LPLND (LPLND group), and 23 patients underwent only TME (TME group). Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group. R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients. We evaluated possible prognostic factors for 5-year overall survival (OS), and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTSFor OS, univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%, P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor. Regarding cumulative local recurrence, the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%, P = 0.833).CONCLUSIONProphylactic LPLND shows no oncological benefits in patients with Stage. low rectal cancer without clinical LPLN metastasis.