直肠癌根治术肠系膜下动脉根部淋巴结的清扫与预后

目的探讨术中进行肠系膜下动脉根部淋巴结清扫对直肠癌预后的影响。方法对临床病理资料完整的260例直肠癌根治术患者的资料进行分析，将是否清扫肠系膜下动脉根部淋巴结（第3站淋巴结）的患者分为非清扫组（D2组，188例）和清扫组（D3组，72例），随访并比较两组患者的预后情况。结果D2组1、3、5年总生存率分别为97．3％、87．2％和77．1％，无瘤生存率分别为93．1％、83．0％和76．8％；D3组1、3、5年总生存率分别为94．4％、79．2％和73．6％，无瘤生存率分别为86．1％、76．4％和71．0％。Kaplan—Meier分析显示，两组总生存率及无瘤生存率差异无统计学意义（P〉0．05）。多元相关分析显示，肠系膜下动脉根部淋巴结清扫与术后复发、转移及总生存时问均无统计学相关性。结论直肠癌根治术中对患者肠系膜下动脉根部进行常规淋巴结清扫并非必要，对预后无显著影响。

Lymphadenectomy adjacent to inferior mesenteric artery root during radical operation and prognosis in rectal cancer]

OBJECTIVE: To investigate the effect of lymphadenectomy adjacent to inferior mesenteric artery root on the prognosis of rectal cancer. METHODS: Clinicopathological data of 260 cases with rectal cancer undergone radical operation were analyzed retrospectively. The patients were divided into two groups. Group D(2): the lymph nodes adjacent to mesenteric artery root were not excised (n=188). Group D(3): the lymph nodes adjacent to mesenteric artery root were excised (n=72). Prognosis of two groups was compared during the follow-up period. RESULTS: In group D(2), the 1-, 3-, 5-year total survival rates (TS) were 97.3%, 87.2% and 77.1%, and tumor-free survival rates (TFS) were 93.1%, 83.0% and 76.8% respectively. In group D(3 ), the 1-, 3-, 5-year total survival rates (TS) were 94.4%, 79.2% and 73.6%, and tumor-free survival rates (TFS) were 86.1%, 76.4% and 71.0% respectively. The differences of TS and TFS between two groups were not significant according to Kaplan-Meier analysis (P>0.05). Multivariate analysis revealed that the excision of lymph nodes adjacent to mesenteric artery root was not statistically correlated with the recurrence, metastasis and survival time after radical operation of rectal cancer. CONCLUSION: Excision of lymph nodes adjacent to inferior mesenteric artery root has no significant impact on prognosis and it is unnecessary in the radical operation of rectal cancer.