乙状结肠癌直肠癌根治手术上方淋巴流向不同清扫平面对预后的影响

The prognostic impact of different upward lymph node surgical plane dissection in colorectal cancer surgery

目的回顾性分析乙状结肠癌、直肠癌根治术中上方淋巴流向不同清扫平面对患者预后的影响。方法回顾性分析本院2003年1月到2008年12月之间的资料完整的716例接受乙状结肠癌、直肠癌根治术患者的临床病理资料,根据不同的肠系膜下动脉结扎水平分为高位结扎组(high ligation,HL)和低位结扎组(low ligation,LL),随访并比较两组的预后情况,分析影响两组预后的影响因素。结果 HL组患者5年总体生存率为74%,LL组患者5年总体生存率为72%,两组差异没有统计学意义(P=0.765)。根据Dukes分期和N分期作分层分析,Dukes各分期和N0、N1分期的两组患者的5年总体生存率没有差异,N2期患者的5年总体生存率差异具有统计学意义(61%vs.43%,P=0.034)。HL组和LL组的复发和转移率差异也没有统计学意义(3.2%vs.3.2%,P=1.0;8.5%vs.8.5%,P=1.0)。结论不同水平结扎不影响乙状结肠癌、直肠癌的总体生存率。但是淋巴结转移个数大于4个者,高位结扎可提高术后生存率。

Objective To analyze retrospectively the prognostic impact of different upward lymph node surgical plane dissection and to evaluate the clinical impact of inferior mesenteric artery (IMA) root lymph node dissection in the sigmoid colon or rectal radical surgery. Methods 716 consecutive patients with sigmoid colon cancer or rectal cancer who underwent radical resection with curative intent for sigmoid colon or rectal cancer in the colorectal cancer database,of whom were divided into two groups, the group of high ligation(HL) and the group of low ligation(LL) according to the ligation plane of inferior mesenteric artery (IMA) were retrospectively analyzed in the First Afifliated Hospital of Sun-Yat Sen University between January 2003 and December 2008. Clinicopathological features, recurrence patterns and overall 5-year survival rates were compared between the two groups. Results The overall 5-year survival rates in HL group and LL group were 74%and 72%respectively. No significant difference was observed between the two groups (P=0.765). The results of subgroup analysis according to Dukes stage and lymph node stage, overall survival difference between HL group and LL group demonstrated that there was no signiifcant difference in the overall 5-year survival rates between the group of N0 group and N1 group in the Dukes stages and there was signiifcant difference in the overall 5-year survival rates in the N2 group(P=0.034) and there were no signiifcant differences in local recurrence rate and distant metastasis rate between the group of HL and the group of LL. Conclusion The overall survival rate was not associated with the different ligation level of IMA in the patients with sigmoid colon or rectal cancer. However, high ligation of IMA could increase the postoperative survival rate for the patients with sigmoid colon or rectal cancer with metastasis of 4 or more lymph nodes.