基于外科与免疫视角思考结直肠癌区域淋巴结处理的功与过

Reflecting on the merits and demerits of regional lymph node management in colorectal cancer based on surgical and immune perspectives

淋巴结是结直肠癌最常见的转移部位,也是外科医生手术切除的重要区域。由于目前转移性淋巴结诊断准确性较低,尤其是反应增生性淋巴结往往被误诊为转移性淋巴结,这也就导致相对激进的淋巴结清扫方式成为结直肠癌外科治疗的常规模式,旨在最大程度清除转移性淋巴结。然而,淋巴结不仅是肿瘤转移的常见靶点,它还是二级淋巴免疫器官,肩负着机体重要的抗肿瘤免疫功能。肿瘤周围区域淋巴结存储大量肿瘤特异性杀伤免疫细胞,这为促进免疫治疗疗效提供极为重要的支撑。因此,"一刀切"式的根治性淋巴结清扫势必会打击和破坏机体免疫状态。基于此,如何看待淋巴结"亦敌亦友"的双重身份,如何对淋巴结进行精准诊治,既能彻底清除转移性淋巴结的同时,又能保留正常淋巴结生理功能,这已成为当下包括结直肠肿瘤在内多数恶性肿瘤亟待解决的重要命题。

Lymph nodes are the most common metastatic sites of colorectal cancer,which is also considered as important areas for surgeons to surgically remove.Due to the low diagnostic accuracy of metastatic lymph nodes,especially enlarged lymph nodes are often misdiagnosed as metastatic lymph nodes,which has led to the expanded lymph node dissection becoming the routine strategy for colorectal cancer,aiming at removing the metastatic lymph nodes to the maximum extent.However,in addition to being a common target for metastasis,lymph nodes are also secondary lymphatic organs,which carry out important anti-tumor immune functions.The regional lymph nodes surrounding the tumor store a large number of tumor-specific immune cells,which provide extremely important immune support to promote the success of immunotherapy.Therefore,excessive lymph node dissection will inevitably bring about a blow to and destroy the immune status of the body.Based on this,how to view the dual identity of lymph nodes as"friend and foe",and how to carry out precise diagnosis and treatment of lymph nodes,so that metastatic lymph nodes can be completely removed while preserving the physiological function of normal lymph nodes,these propositions have become important propositions that need to be solved for most malignant tumors,including colorectal cancer.