直肠癌侧方淋巴结清扫争议与共识

Lateral lymph node dissection for rectal cancer:controversy and consensus

直肠癌盆腔侧方淋巴结清扫是直肠癌手术治疗的重要方式之一,随着新辅助放化疗技术的应用,该术式在欧美及我国已较少开展。目前,对该技术的研究主要来自日本及韩国等国家。而该术式对于降低直肠癌局部复发率及改善病人远期生存是否有意义,尤其是预防性侧方淋巴结清扫的作用,尚存在争议。对于新辅助放化疗后仍有侧方淋巴结转移的病人,目前多主张应行侧方淋巴结清扫,而对于侧方淋巴结转移的诊断有赖于影像学的精确判断。该术式虽是创伤较大的手术,但其目前仍是直肠癌外科手术的重要组成部分,应个体化选择病人并结合腹腔镜及机器人等微创技术,提高治疗效果。

Lateral lymph node dissection （LLND） is one of the important operations for the treatment of rectal cancer. With the application of the neoadjuvant chemoradiation therapy, this operation is less performed in the Europe, America and China. Currently, the researches on this operation are mainly from Japan and South Korea. There is controversy of its effect on the lowering the local recurrence and improving the long-term outcomes, especially for the prophylactic LLND. For the patients with suspected lateral lymph node metastasis after neoadjuvant chemoradiotherapy, LLND is commonly indicated. The diagnosis of lateral lymph node metastasis is relied on the precise assessment of imaging. LLND is one kind of massively invasive procedure, but it is one important component of the operations for rectal cancer.Combining with mini-invasive techniques of the laparoscopic and robotic procedures, LLND can be selectively applied to improve the outcomes for the indicated patients.