目的:明确直肠肿瘤远端系膜内淋巴结转移状况,探讨全直肠系膜切除术的合理性。方法:以脂肪"清洗"技术检查78例全直肠系膜切除术直肠癌患者术后标本。结果:19.2%的患者在肿瘤远端的系膜内发生了淋巴结转移,均见于 pT3、pT4患...目的:明确直肠肿瘤远端系膜内淋巴结转移状况,探讨全直肠系膜切除术的合理性。方法:以脂肪"清洗"技术检查78例全直肠系膜切除术直肠癌患者术后标本。结果:19.2%的患者在肿瘤远端的系膜内发生了淋巴结转移,均见于 pT3、pT4患者。其中2 cm 以内者15.4%,2 cm 以外者3.8%。上段直肠癌最远处转移淋巴结距肿瘤4cm,中下段最远3 cm。结论:对 T3、T4患者施行全直肠系膜切除术是合理的。展开更多
Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a re...Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a retrospective chart review of all patients who had undergone total pelvic exenteration for a gynecologic malignancy between July 1992 and December 2003. Patient charts were reviewed for information regarding demographics, site of cancer, histology, pathology report, and time to recurrence. Results. Fifty-eight women had undergone total pelvic exenteration for recurrent gynecologic malignancies during the study period and 57 were available for analysis. Primary cancer site was as follows: cervix, 37 (65% ); vagina, 8 (14% ); vulva, 5 (9% ); and uterine corpus, 7 (12% ). In 30 patients (53% ), the mesorectal lymph node status was pathologically evaluated. Of these 30 patients, 3 (10% ) had positive mesorectal lymph nodes at the time of total pelvic exenteration. All 3 patients had rectal wall involvement (rectal submucosa, 2; rectal mucosa, 1), and all 3 patients recurred within 4 months of pelvic exenteration. The median time to recurrence after surgery was 2.4 months in those patients with positive mesorectal lymph nodes compared with 7.3 months in those with negative mesorectal lymph nodes (P = 0.005). When individually adjusted for other prognostic variables, such as margin status, tumor grade, lymphovascular space involvement, primary cancer site, and histologic type, a finding of positive mesorectal lymph nodes was associated with a shorter time to recurrence of disease (all < 0.05). Conclusions. Mesorectal lymph node involvement is a common finding at total pelvic exenteration, particularly in patients with rectal wall involvement. Patients with positive mesorectal lymph nodes appear to have a worse outcome with a shorter time to recurrence of disease.展开更多
文摘目的:明确直肠肿瘤远端系膜内淋巴结转移状况,探讨全直肠系膜切除术的合理性。方法:以脂肪"清洗"技术检查78例全直肠系膜切除术直肠癌患者术后标本。结果:19.2%的患者在肿瘤远端的系膜内发生了淋巴结转移,均见于 pT3、pT4患者。其中2 cm 以内者15.4%,2 cm 以外者3.8%。上段直肠癌最远处转移淋巴结距肿瘤4cm,中下段最远3 cm。结论:对 T3、T4患者施行全直肠系膜切除术是合理的。
文摘Objectives. To determine the incidence and prognostic implications of positive mesorectal lymph nodes in patients undergoing total pelvic exenteration for recurrent gynecologic malignancies. Methods. We performed a retrospective chart review of all patients who had undergone total pelvic exenteration for a gynecologic malignancy between July 1992 and December 2003. Patient charts were reviewed for information regarding demographics, site of cancer, histology, pathology report, and time to recurrence. Results. Fifty-eight women had undergone total pelvic exenteration for recurrent gynecologic malignancies during the study period and 57 were available for analysis. Primary cancer site was as follows: cervix, 37 (65% ); vagina, 8 (14% ); vulva, 5 (9% ); and uterine corpus, 7 (12% ). In 30 patients (53% ), the mesorectal lymph node status was pathologically evaluated. Of these 30 patients, 3 (10% ) had positive mesorectal lymph nodes at the time of total pelvic exenteration. All 3 patients had rectal wall involvement (rectal submucosa, 2; rectal mucosa, 1), and all 3 patients recurred within 4 months of pelvic exenteration. The median time to recurrence after surgery was 2.4 months in those patients with positive mesorectal lymph nodes compared with 7.3 months in those with negative mesorectal lymph nodes (P = 0.005). When individually adjusted for other prognostic variables, such as margin status, tumor grade, lymphovascular space involvement, primary cancer site, and histologic type, a finding of positive mesorectal lymph nodes was associated with a shorter time to recurrence of disease (all < 0.05). Conclusions. Mesorectal lymph node involvement is a common finding at total pelvic exenteration, particularly in patients with rectal wall involvement. Patients with positive mesorectal lymph nodes appear to have a worse outcome with a shorter time to recurrence of disease.
