结直肠癌手术肠系膜血管根部淋巴结清扫与预后的相关性

目的 分析结直肠癌根治性手术中不同淋巴结清扫范围对预后的影响,探讨肠系膜血管根部淋巴结清扫的临床意义。方法 收集本院1985--2000年收治的大肠癌患者,对其中首次在本院接受结直肠癌根治术的1409例患者资料进行整理分析,并将患者按是否清扫肠系膜血管根部淋巴结（即第3站淋巴结）分为两组,其中清扫（D3）组857例,非清扫（D2）组552例,随访并比较两组患者的预后。结果 D3组全部患者的1、3、5和10年总生存率分别为90．32％、81．38％、77．04％和73．02％;D2组患者的1、3、5和10年总生存率分别为91．04％、84．12％、79．33％和76．17％;D3组患者的1、3、5和10年无瘤生存率分别为89．93％、79．44％、74．52％和70．33％;D2组患者的1、3、5和10年无瘤生存率分别为90．00％、82．69％、76．02％和71．80％;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）。随访全部患者6～289个月,D3组857例患者中,42例（4．90％）复发,79例（9．22％）转移;D2组552例患者中,30例（5．43％）复发,60例（10．87％）转移,两组复发和转移率差异无统计学意义。多元相关分析显示,是否清扫肠系膜血管根部淋巴结与术后复发、转移及生存时间均无统计学相关性。结论 结直肠癌根治术中对患者肠系膜血管根部淋巴结清扫并非必要,对预后无显著影响。

Correlation between dissection of lymph nodes adjacent to mesenteric artery pedicle and prognosis in colorectal cancer patients

Objective To analyze the impact of radical surgery with different extent of lymph nodes dissection on the prognosis of colorectal carcinoma patients and to see if lymph nodes adjacent to mesenteric artery root should be excised. Methods Data of 1409 cases with colorectal carcinoma treated in Shanghai Cancer Hospital during 1985-2000 were collected. These patients had primary colorectal carcinoma treated by radical surgery with different extent of lymph nodes excision. They were divided into two groups: in group D3 the lymph nodes adjacent to mesenteric artery root were excised (n=857), while in group D2 (n=552) were not. The time of follow-up was 6~289 months (median: 48 months).Results The 1-, 3-, 5-, 10-year total survival rates (TS) in group D3 patients were 90.3%,81.4%, 77.0% and 73.0%, respectively. The 1-, 3-, 5-, 10-year tumor-free survival rates (TFS) in group D3 patients were 89.9%,79.4%, 74.5% and 70.3%, respectively. In group D2 patients, the 1-, 3-, 5-, 10-year TS were 91.04%, 84.12%, 79.33% and 76.17%, and those of TFS were 90.0%, 82.7%, 76.0% and 71.8%, respectively. The differences in TS and TFS in the two groups of patients were not significant according to Kaplan-Meier analysis (P>0.05). During the follow-up period, 42 patients in group D3 had local recurrence (4.9%), while in group D2 the rate of local recurrence was 5.4% (P>0.05). Metastases developed in 79 cases in group D3 and in 60 cases in group D2 (P>0,05). Multivariate analysis revealed that the excision of lymph nodes adjacent to mesenteric artery pedicle did not statistically correlate with recurrence, metastasis and survival time after radical operation of colorectal cancer.Conclusion Excision of lymph nodes adjacent to the mesenteric artery root has no significant impact on prognosis and is unnecessary in the radical surgery for colorectal carcinoma.