低位直肠癌侧方转移和微转移的临床病理学研究

目的探讨低位直肠癌盆腔侧方淋巴结转移、微转移规律及其对预后的预测价值。方法运用大组织切片、组织芯片研究67例低位直肠癌手术标本,并分析其随访资料。结果12例标本检获盆腔侧方淋巴结癌转移,另有10例存在微转移,82．9％的转移淋巴结直径〈5mm。髂内血管、闭孔、髂内远端内侧分支等处淋巴结受累率较高。侧方转移、微转移病例术后复发多,生存时间短。结论低位直肠癌存在盆腔侧方转移,各区域受累率不一。侧方转移病例预后差,提示术前／术后辅助治疗的价值。

Lateral pelvic metastasis and micrometastasis in low rectal cancer

OBJECTIVE: To study lateral pelvic metastasis and micrometastasis of low rectal cancer and elucidate their prognostic value. METHODS: Whole-mount slice and tissue microarray of dissected lateral pelvic specimen from 67 cases of low rectal cancer were examined, and the included cases were followed up. RESULTS: Twelve specimens were diagnosed as lateral metastasis, while another 10 were proved to bear micrometastasis. Most of the involved metastatic lymph nodes (82.9%) were smaller than 5 mm in diameter. Internal iliac, obturator regions and middle rectal root were more likely to be involved by tumors. Patients with lateral metastasis suffered more recurrence and poorer survival. CONCLUSIONS: Lateral pelvic metastasis could be observed in low rectal cancer and its incidence differed among lateral pelvic regions. Patients with lateral spread predisposed poor prognosis, thus underlies the value of pre/postoperative adjuvant therapy.