直肠癌侧方淋巴结转移清扫术后的生存分析

Analysis of survival of patients with lateral lymph node metastasis after lateral lymph node dissection rectal cancer

目的 回顾性分析腹腔镜直肠癌层面优先入路侧方淋巴结清扫病人侧方淋巴结及肠系膜淋巴结的转移特点及生存预后。方法 收集2017年5月至2022年12月天津市人民医院进行腹腔镜层面优先入路侧方淋巴结清扫的病人临床资料,对病人侧方淋巴结及肠系膜淋巴结的转移情况与生存预后进行分析(应用COX风险模型进行分析),从而探讨侧方淋巴结转移应归属于局部转移还是远处转移。结果 共纳入111例病人,通过COX比例风险模型对“肠系膜(-)侧方(+)”组(20例)和“肠系膜(+)侧方(+)”组(58例)病人的生存数据进行分析显示,“肠系膜(-)侧方(+)”组3年生存率为58%,“肠系膜(+)侧方(+)”组3年生存率为59.8%,与文献报道相比,两组生存曲线与直肠癌淋巴结转移分期的N_2期生存曲线一致,3年生存率与直肠癌N_2期相近。结论 直肠癌侧方淋巴结转移而直肠系膜淋巴结未转移的病人预后可能与直肠癌N_2期的病人相似,优于Ⅳ期直肠癌病人,提示直肠癌侧方淋巴结转移应归属于区域淋巴结转移而非远处转移。

Objective To retrospectively explore the metastasis characteristics and survival outcomes of lateral and mesenteric lymph nodes after laparoscopic lateral lymph node dissection(LLND)via a facical space priority approach for rectal cancer.Methods From May 2017 to December 2022,the relevant clinical data were collected of 111 patients undergoing laparoscopic lateral lymph node dissection via a facical space priority approach.The status of lateral and mesenteric lymph node metastasis and survival prognosis were examined whether or not lateral lymph node metastasis should be classified as local or distant Results The survival curves of mesentery(-)lateral(+)(n=20)and mesentery(+)lateral(+)(n=58)groups were analyzed by COX survival curve.The 3-year survival rate of mesentery(-)lateral(+)group(n=20)was 58%and that of mesentery(+)lateral(+)group(n=58)59.8%.The survival curve of two groups was consistent with survival curve of N_(2) stage rectal cancer and 3-year survival rate was similar to that of N_(2) stage rectal cancer.Conclusion The outcomes of rectal cancer patients with lateral lymph node metastasis without mesorectal lymph node metastasis may be similar to that of those with N_(2) stage rectal cancer and much better than that of those with stage Ⅳ rectal cancer.It implies that lateral lymph node metastasis may be classified as regional rather than distant.