Non-surgical factors influencing lymph node yield in colon cancer

There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colonic resection specimen LN yield and to summarise the pertinent literature on these topics.A literature review of Pub Med was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens.The terms used for the search were:LN,lymphadenectomy,LN yield,LN harvest,LN number,colon cancer and colorectal cancer.Both nonmodifiable and modifiable factors were identified.The review identified fifteen non-surgical factors:(13 nonmodifiable,2 modifiable) which may influence LN yield.LN yield is frequently reduced in older,obese patients and those with male sex and increased in patients with right sided,large,and poorly differentiated tumours.Patient ethnicity and lower socioeconomic class may negatively influence LN yield.Pre-operative tumour tattooing appears to increase LN yield.There are many factors that potentially influence the LN yield,although the strength of the association between the two varies greatly.Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.

Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma

AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.

甲状腺微小乳头状癌患者颈部中央淋巴结清扫术后假阴性风险概率的评估

目的:通过大样本甲状腺微小乳头状癌(PTMC)队列建立概率模型,量化颈部中央淋巴结(简称中央淋巴结)清扫术后残余转移性淋巴结风险。方法:回顾性分析2007—2020年昆明医科大学第一附属医院甲状腺疾病诊治中心诊断为PTMC、由高手术量医生执行甲状腺切除+中央淋巴结清扫且至少检测1枚淋巴结的病例,进一步描述阳性淋巴结的分布特征并建立评价隐匿性转移性淋巴结风险的数学模型。使用β-二项分布估计隐匿性转移性中央淋巴结的概率作为淋巴结清扫(检测)数的函数。结果:概率模型共纳入5399例连续病例,观察到转移性中央淋巴结1664例(30.8%)。经过模型校正,真实淋巴结转移率由30.8%升高至38.9%。在清扫(检测)1枚淋巴结时,中央淋巴结假阴性的概率为31.3%,而当清扫(检测)7枚和12枚淋巴结时,假阴性的概率分别降低至10.0%和4.9%。合并桥本甲状腺炎病例的概率模型敏感性分析与主分析显示基本一致的稳健结果。结论:本研究量化了PTMC患者中央淋巴结清扫术后的隐匿性残余转移性淋巴结风险,可以作为评估术后复发/残余风险的补充指标,也为通过回顾性数据资料评估残余转移性淋巴结对肿瘤患者预后的影响提供新的方法。

淋巴结检出数对直肠癌治疗影响的研究进展

目前直肠癌在我国发病率及病死率不断上升,各种有关直肠癌治疗和预后因素的研究在不断展开。病理分期不论对于直肠癌的治疗或是预后均具有重要意义。现阶段直肠癌的主要病理分期方法为肿瘤转移节点(tumor-node-metastasis,TNM)分期及Duke分期,肿瘤的分期结果可用来预测患者预后情况以及决定术后治疗方案。N分期取决于患者阳性淋巴结转移数。但N分期在对直肠癌预后的预测上存在局限性,而淋巴结检出数(lymph node yield,LNY)与淋巴结转移度(lymph node ratio,LNR)对分期及预后的意义逐渐受到人们的重视。LNY的增加有助于更准确的病理分期,改善患者预后,其主要受新辅助放射治疗和化学治疗、肿瘤解剖及病理性质如直径大小、浸润深度等以及患者自身因素影响;目前用于提高LNY的临床技术主要有脂肪清除法、染色剂淋巴示踪等,但都存在各自的局限性。LNR是将转移淋巴结数与LNY结合起来的一项指标。无论手术标本LNY是否足够,LNR比N分期对直肠癌的预后更具有意义。

Dealing with robot-assisted surgery for rectal cancer:current status and perspectives

The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition threedimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.

直肠黏膜下层注射纳米炭混悬注射液对中低位直肠癌新辅助治疗后淋巴结检出情况及吻合口安全性的影响分析

目的探讨直肠黏膜下层注射纳米炭混悬注射液对中低位直肠癌新辅助治疗后淋巴结检出情况及吻合口安全性的影响。方法回顾性分析广州中医药大学第一附属医院肛肠科2017年1月至2021年1月收治的72例中低位直肠癌患者的临床资料,患者均在新辅助治疗后行保肛根治术治疗。将其中于术前24 h经肛门镜引导在齿状线上方2 cm处直肠黏膜下层注射纳米炭混悬注射液的31例患者归为观察组,将未注射纳米炭混悬注射液的41例患者归为对照组。比较两组淋巴结检出相关情况、吻合口相关并发症发生情况。结果观察组平均淋巴结检出数目较对照组多,淋巴结检出数目≥12枚的患者比例较对照组高,差异均有统计学意义(均P<0.05);两组平均阳性淋巴结检出数目及淋巴结转移患者比例比较差异均无统计学意义(均P>0.05)。两组吻合口漏、吻合口出血、吻合口狭窄、吻合口周围脓肿发生率比较差异均无统计学意义(均P>0.05)。结论经肛门镜引导于直肠黏膜下层注射纳米炭混悬注射液是一种安全、简便、易于操作的方法,可增加新辅助治疗后中低位直肠癌手术标本淋巴结检出数目,同时不增加吻合口相关并发症。