病理科医师细致取材对直肠癌根治术后淋巴结检出数量的影响

Impact of meticulousness of pathologists on lymph node harvest after radical resection of invasive rectal carcinoma

目的分析病理科医师细致取材对直肠癌根治手术患者淋巴结检出数量的影响。方法对第二军医大学附属长海医院肛肠外科2008年1。12月和2009年1。5月收治的原发性直肠癌患者（Ⅰ～Ⅲ期）临床资料进行回顾性分析，比较2008年间（2008年组）和2009年间（自2009年1月起，病理科建议每例直肠癌患者手术检出淋巴结数量不少于15枚；2009年组）患者的淋巴结检出数量。结果232例直肠癌患者入组．其中2008年组156例，2009年组76例。两组患者性别（P=0．436）、年龄（P=0．527）、肿瘤距肛缘距离（P=0．761）、肿瘤分化程度（P=0．074）和TNM分期（P=0．167）及手术方式（P=0．715）的比较，差异均无统计学意义。2009年组检出淋巴结数量[（16．0±0．3）枚／例]显著高于2008年组[（11．4±0．3）枚／例]（P〈0．01）；2009年组检出淋巴结达12枚／例者的比例94．7％（72／76例），显著高于2008年组的45．5％（71／156例），差异有统计学意义（P〈0．01）。结论对未行术前新辅助治疗、且无远处转移的直肠癌根治术患者．病理科医师细致取材可以获得理想的淋巴结检出数量。

Objective To analyze the impact of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma. Methods From January 2008 to May 2009, the clinical data of rectal cancer patients undergone operation were reviewed retrospectively. After multidisciplinary cooperation on rectal cancer, a new rule was applied to request the pathologists to find no less than 15 nodes in single colorectal specimen from January 2009. Patients were divided into two groups （2008 group and 2009 group） and the node harvest numbers were compared. Excluded criteria were recurrent colorectal tumor, Tis tumor, R1 or R2 resection, tumor resection transanally or endoscopically, the cases enrolled in other prospective research, synchronous diseases affecting the surgical procedure for the rectal cancer （familial adenomatous polyposis, synchronous colorectal carcinoma） and rectal cancer receiving neoadjuvant chemoradiation. Statistical analysis was performed using One-Sample Kolmogorov- Smirnov test, Mann-Whitney test, Independent-Samples T test and Chi-Square test （SPSS 15.0）. Results A total of 232 patients were identified, including 76 cases in the 2009 group and 156 cases in 2008 group. The lymph node retrieval in the 2009 group was significantly more than that in 2008 group （16.0±0.3 vs 11.4±0.3, P〈0.01）. A significantly higher percentage of patients was found in 2009 group with a lymph node harvest equal to or more than 12 nodes （72/76 vs 71/156, P〈0.01）. There were no significant differences in gender （46/76 vs 86/156, P=0.436）, age （58.1±1.3 vs 59.2±1.1,P=0.527）, distance from tumor to anal verge （7.4±0.4 vs 7.1±0.3, P=0.761）, proportion of sphincter-sparing surgery （67/76 vs 140/156, P=0.715）, ratio of well and moderate differentiated tumors （68/76 vs 125/156, P=0.074） and overall TNM stage （P=0.167） between the two groups. Conclusions The lymph node harvest in 2009 group is significantly more than that in 2008 group. The good performance of pathologists could produce adequate number of lymph nodes for rectal cancer without neoadjuvant chemoradiation.