大肠癌淋巴转移规律与手术范围的关系

目的 研究进展结肠直肠癌淋巴结转移规律,指导手术根治范围,方法 分析７４例结肠直肠癌行Ｄ３式根治术切除的淋巴结６２３个,按肿瘤旁,肠管纵轴和中枢方向行淋巴结分组,分站计算淋巴结转移率和转移度。结果 肿瘤旁淋巴结转移率为４７．２％,转移度为３８．６％,阳性淋巴结占６１．２％,肠管纵轴方向淋巴结转移率为２２．８％,转移度为１８．６％,阳性淋巴结占１７．１％,并与距肿瘤的距离和方向有关。中枢方向阳性淋巴

Colorectal cancer: lymphatic metastasis and choice of operation

OBJECTIVE: To study lymphatic metastasis of colorectal cancer for deceding the of dissection extent of dissection. METHODS: Six hundred and twenty-three lymph nodes from 74 cases of colorectal cancer were analyzed after D(3) resection. They were classified into peritumor, longitudinal spread, and upward spread groups. The metastasis rate of lymph node and its incidence were calculated. RESULTS: The metastasis rate of lymph node and its incidence in the peritumor, longitudinal spread, and upward spread (N(2) and N(3)) groups were 47.2% and 38.6%, 22.8% and 18.6%, and 29.7% (20.3% and 9.4%) and 10.2% (19.0% and 5.3%), respectively. The distribution rate of metastatic lymph node was 61.2%, 17.1%, and 21.6% in the peritumor, longitudinal spread, and upward spread groups, respectively. Within 2.0 cm on the anal side of rectal cancer, the metastasis rate was 3.7%, whereas in 2.0 - 4.0 cm no metastasis was observed cancer at the lower part of the rectum demonstrated a higher lateral metastasis rate. CONCLUSIONS: Colorectal cancer tends to metastasize to longitudinal and the risk of metastasis increased in the stage of pT(3) and pT(4) or low differentiation stage. Jump metastasis is also a feature. D(3) radical resection is necessary for colorectal cancer, but extended lateral lymph node needs enectomy or total mesorectal excision. No residual tumor tissue exists at the anastomosis site after low anterior resection when the excision distance is beyond 2.0 cm from the anal margin of rectal cancer.