右半结肠癌No.206组淋巴结转移的观察研究

Observational study of No.206 lymph nodes metastasis in right colon cancer patients

目的:分析右半结肠癌No.206组淋巴结转移的规律,为淋巴结的清扫提供临床参考。方法:回顾性收集2015年1月至2019年12月完成的111例右半结肠癌根治术患者的临床资料。观察指标:人口学特征、手术与术后恢复情况、术后病理学检查、随访及生存情况。结果:111例患者中男59例,女52例,中位年龄60岁。肿瘤部位回盲部9例,升结肠37例,结肠肝曲62例,横结肠右侧3例。患者均顺利完成右半结肠癌根治术,其中腹腔镜手术79例,开放手术8例,达芬奇手术24例;腹腔镜手术中1例中转开腹。手术时间110(98,115)min,术中出血量30(20,50)mL,术后肛门排便时间4(3,5)d,术后住院7(6,8)d。术后总并发症发生率9.9%(11/111),其中切口感染、脂肪液化5例,乳糜瘘5例,吻合口出血1例。病理标本肿瘤TNM分期Ⅰ期17例、Ⅱ期44例、Ⅲ期49例、Ⅳ期1例。淋巴结检出27(23,31)枚,阳性淋巴结检出0(0,2)枚,淋巴结转移率为44.14%(49/111)。No.206组淋巴结检出数为3(1,4)枚,阳性淋巴结检出数为0(0,0)枚,淋巴结转移率为0.9%(1/111)。术后102例(91.9%)获得随访,9例失访,随访7~65个月,中位随访时间23个月。5年总生存率86.3%,5年无病生存率73.4%。结论:右半结肠癌No.206组淋巴结转移率较低,如果术前或术中评估怀疑No.206组淋巴结转移或局部进展期肝曲结肠癌,建议清扫No.206组淋巴结。

Objective:To investigate the pattern of No.206 lymph nodes metastasis in right colon cancer patients in order to provide clinical reference of lymph nodes dissection.Methods:Clinical pathological data of 111 right colon cancer patients receiving radical operation from Jan.2015 to Dec.2019 were retrospectively analyzed.Observation indicators included demographic characteristics,intraoperative conditions,postoperative recovery,postoperative pathological examinations,follow-up and survival.Results:Among the 111 patients,there were 59 male and 52 female patients.The median age was 60 years.There were 9 patients with tumor located in the cecum,37 in the ascending colon,62 in the hepatic flexure and 3 in the right side of transverse colon.All patients underwent right-hemicolectomy successfully.79 patients were performed with laparoscopic surgery,8 with open surgery and 24 with Da Vinci robotic surgery.One laparoscopy was converted to laparotomy.Operation time was 110(98,115)min.Operative blood loss was 30(20,50)mL.Time for the first postoperative bowel movement was 4(3,5)d.Postoperative hospital stay was 7(6,8)d.The total complication rate was 9.9%(11/111),with 5 cases of incision fat liquefaction/infection,5 chylous fistula and 1 anastomotic bleeding.There were 17 cases of TNM stage Ⅰ,44 cases of stage Ⅱ,49 cases of stage Ⅲ and 1 case of stage Ⅳ.The median total lymph node count was 27(23,31),median positive lymph node count was 0(0,2).The metastasis rate of lymph node was 44.14%(49/111).With respect to No.206 lymph nodes,the median number of its harvest was 3(1,4),median positive lymph node count was 0(0,0).The metastasis rate of No.206 lymph nodes was 0.9%(1/111).102(91.9%)patients were followed up with a median time of 23 months(range 7 to 65 months).9 patients were lost to follow-up.The 5-year overall survival rate and the 5-year tumor-free survival rate were 86.3% and 73.4%,respectively.Conclusions:Concerning the low metastasis rate of No.206 lymph nodes of right colon cancer,lymph node dissection is recommended in patients with locally advanced colon cancer in hepatic flexure or suspected No.206 lymph nodes metastasis.