进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义

Selection and significance of lateral lymph node dissection in advanced low rectal cancer after neoadjuvant chemoradiotherapy

侧方淋巴引流是低位直肠癌3个重要的淋巴引流方向之一。沿引流途径清扫淋巴结是直肠癌根治术基本要求,也决定淋巴结清扫范围。但侧方淋巴结是区域淋巴结还是远处淋巴结,一直存在争议。这带来新辅助放化疗和侧方淋巴结清扫、以及新辅助放化疗对侧方淋巴结转移疗效的争议。笔者综合分析国内外研究进展,对直肠癌侧方淋巴结转移规律、影响侧方淋巴结转移复发危险因素以及放化疗前后MRI检查对侧方淋巴结评估等进行深入阐述,并结合临床实践,探讨进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义。

Lateral lymphatic drainage is one of the three important directions for low rectal cancer.Radical surgery of rectal cancer requires the dissection of lymph nodes along the drainage route which determines the extent of lymph node dissection.However,controversial arguments exist whether lateral lymph node belonging to the regional lymph node or the distant lymph node.This arguments has also brought the controversy about neoadjuvant chemoradiotherapy and lateral lymph node dissection,as well as the controversy about efficacy of neoadjuvant chemoradiotherapy on lateral metastatic lymph nodes.Combined with the preliminary clinical practices,the authors comprehensively analyze research advances at home and abroad,further elaborate the lateral lymph node metastasis of rectal cancer,the risk factors affecting lateral lymph node metastasis and tumor recurrence,and the evaluation of lateral lymph node by magnetic resonance imaging before and after chemoradiotherapy,et al,in order to investigate the selection and significance of lateral lymph node dissection in advanced low rectal cancer after neoadjuvant chemoradiotherapy.