切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 182 -189. doi: 10.3877/cma.j.issn.2095-3224.2023.03.002

侧方淋巴结清扫专栏

侧方淋巴结清扫术在直肠癌手术治疗中的研究进展
王文钦, 王培鑫, 周少飞()   
  1. 261100 青岛市市立医院普通外科
  • 收稿日期:2022-06-25 出版日期:2023-06-25
  • 通信作者: 周少飞
  • 基金资助:
    青岛市科技惠民示范专项-2022年生命健康新立项项目(22-3-7-smjk-4-nsh)

Research progress of lateral lymph node dissection in the surgical treatment of rectal cancer

Wenqin Wang, Peixin Wang, Shaofei Zhou()   

  1. Department of General Surgery, Qingdao Municipal Hospital, Qingdao 261100, China
  • Received:2022-06-25 Published:2023-06-25
  • Corresponding author: Shaofei Zhou
引用本文:

王文钦, 王培鑫, 周少飞. 侧方淋巴结清扫术在直肠癌手术治疗中的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(03): 182-189.

Wenqin Wang, Peixin Wang, Shaofei Zhou. Research progress of lateral lymph node dissection in the surgical treatment of rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(03): 182-189.

全直肠系膜切除术(TME)是中低位直肠癌手术治疗的金标准。相比之下,是否加做侧方淋巴结清扫(LLND),在世界范围内仍然存在较大的争议。本文通过回顾近年来关于直肠癌的LLND术相关的研究文献,总结目前LLND的研究现状,存在的争议、手术技巧及入路,以期全面探讨LLND术在直肠癌中的应用现状,亟待解决的争议,为以后LLND术在直肠癌中的精准应用提供理论支持和文献参考。

Total mesorectal excision (TME) is the gold standard for surgical treatment of rectal cancer. In contrast, whether to add lateral lymph node dissection (LLND) is still controversial worldwide. By reviewing the research literature related to lateral lymph node dissection for rectal cancer in recent years, this paper summarizes the current research status, controversies, surgical techniques and approaches of lateral lymph node dissection, in order to comprehensively discuss the application status of lateral lymph node dissection in rectal cancer, and the research worth in the future. To provide theoretical support and literature reference for the accurate application of lateral lymph node dissection in rectal cancer.

图1 直肠癌的淋巴结引流及侧方淋巴结的范围3(注释:红:肠旁淋巴结,蓝:中间淋巴结,黄:侧方淋巴结,白:比侧方淋巴结更接近中间的淋巴结)
表1 不同地区指南解读
图2 直肠癌中侧壁淋巴结的诊疗策略(图片来自文献[41])。注:nCRT:新辅助放化疗;TME:全直肠系膜切除;LLND:侧方淋巴结清扫术
图3 TEP手术入路56。3A:打孔位置;3B:手术入路间隙为腹膜外间隙
[1]
You YN, Hardiman KM, Bafford A, et al. On behalf of the clinical practice guidelines committee of the american society of colon and rectal surgeons. The american society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer[J]. Dis Colon Rectum, 2020, 63(9): 1191-1222.
[2]
Xynos E, Tekkis P, Gouvas N, et al. Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)[J]. Annals of Gastroenterology, 2016, 29(2): 103-126.
[3]
练磊, 谢明颢. 从“两面三道”浅谈直肠癌手术侧方淋巴结清扫的技巧——复杂问题简单化的一个思考[J]. 中华胃肠外科杂志, 2019, 22(6): 597-600.
[4]
Yamaguchi T, Konishi T, Kinugasa Y, et al. Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: a subgroup analysis of a large multicenter cohort study in Japan[J]. Diseases of the Colon & Rectum, 2017, 60(9): 954.
[5]
Williamson JS, Quyn AJ, Sagar PM. Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management[J]. Br J Surg, 2020, 107(12): 1562-1569.
[6]
Kobayashi H, Mochizuki H, Kato T, et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection[J]. Diseases of the Colon & Rectum, 2009, 52(4): 567-576.
[7]
Nagawa H, Muto T, Sunouchi K, et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy[J]. Dis Colon Rectum, 2001, 44(9): 1274-1280.
[8]
Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer[J]. Am J of Surg, 1982, 144(3): 350-354.
[9]
Koyama Y, Moriya Y, Hojo K. Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum--significant improvement of survival rate and decrease of local recurrence[J]. Jpn J Clin Oncol, 1984, 14(4): 623-632.
[10]
Moriya Y, Hojo K, Sawada T, et al. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection[J]. Diseases of the Colon & Rectum, 1989, 32(4): 307-315.
[11]
Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer[J]. Int J Clin Oncol, 2020, 25(1): 1-42.
[12]
Leyh-Bannurah SR, Budäus L, Zaffuto E, et al. Adherence to pelvic lymph node dissection recommendations according to the National Comprehensive Cancer Network pelvic lymph node dissection guideline and the D'Amico lymph node invasion risk stratification[J]. Urol Oncol, 2018, 36(2): 81.e17-81.e24.
[13]
Wisner KPA, Ahmad S, Holloway RW. Indications and techniques for robotic pelvic and para-aortic lymphadenectomy with sentinel lymph node mapping in gynecologic oncology[J]. Best Pract Res Clin Obstet Gynaecol, 2017, 45: 83-93.
[14]
Atef Y, Koedam TW, Oostendorp S, et al. Lateral pelvic lymph node metastases in rectal cancer: A systematic review[J]. World J Surg, 2019, 43(12): 3198-3206.
[15]
Otero de Pablos J, Mayol J. Controversies in the management of lateral pelvic lymph nodes in patients with advanced rectal cancer: east or west?[J]. Frontiers in Surgery, 2019, 6: 79.
[16]
EURECCA colorectal. Multidisciplinary management: European consensus conference colon & rectum[J]. Eur J Cancer, 2014, 50(1): 1.e1-1.e34.
[17]
Christou N, Meyer J, Combescure C, et al. Prevalence of metastatic lateral lymph nodes in asian patients with lateral lymph node dissection for rectal cancer: a meta-analysis[J]. World J Surg, 2021, 45(5): 1537-1547.
[18]
Sugihara K, Kobayashi H, Kato T, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer[J]. Dis Colon Rectum, 2006, 49(11): 1663-1672.
[19]
Ueno M, Oya M, Azekura K, et al. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer[J]. Br J Surg, 2010, 92(6): 756-763.
[20]
Shimoyama M, Yamazaki T, Suda T, et al. Prognostic significance of lateral lymph node micrometastases in lower rectal cancer[J]. Dis Colon Rectum, 2003, 46(3): 333-339.
[21]
Yang X, Hu T, Gu C, et al. The prognostic significance of isolated tumor cells detected within lateral lymph nodes in rectal cancer patients after laparoscopic lateral lymph node dissection[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(11): 1462-1468.
[22]
Group MS. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer[J]. Br J Surg, 2011, 98(12): 1798-1804.
[23]
Akiyoshi T, Ueno M, Matsueda K, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging[J]. Ann Surg Oncol, 2014, 21(1): 189-196.
[24]
Kasai S, Shiomi A, Kagawa H, et al. The effectiveness of machine learning in predicting lateral lymph node metastasis from lower rectal cancer: a single center development and validation study[J]. Ann Gastroenterol Surg, 2021, 6(1): 92-100.
[25]
Ma P, Yuan Y, Yan P, et al. The efficacy and safety of lateral lymph node dissection for patients with rectal cancer: A systematic review and meta-analysis[J]. Asian Journal of Surgery, 2020, 43(9): 891-901.
[26]
Georgiou P, Tan E, Gouvas N, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis[J]. Lancet Oncol, 2009, 10(11): 1053-1062.
[27]
Fujita S, Akasu T, Mizusawa J, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial[J]. Lancet Oncol, 2012, 13(6): 616-621.
[28]
Oki E, Shimokawa M, Ando K, et al. Effect of lateral lymph node dissection for mid and low rectal cancer: An ad-hoc analysis of the ACTS-RC (JFMC35-C1) randomized clinical trial[J]. Surgery, 2019, 165(3): 586-592.
[29]
Watanabe T, Tsurita G, Muto T, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers[J]. Surgery, 2002, 132(1): 27-33.
[30]
Chew C, Hoskin P, Davies J, et al. Colorectal cancer: NICE guideline [NG151][EB/OL]. (2020-02-29)[2022-06-25].

URL    
[31]
Ozawa H, Kotake K, Hosaka M, et al. Impact of lateral pelvic lymph node dissection on the survival of patients with T3 and T4 low rectal cancer[J]. World J Surg, 2016, 40(6): 1492-1499.
[32]
Ishihara S, Kanemitsu Y, Murono K, et al. Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis[J]. Int J Colorectal Dis, 2016, 31(7): 1-7.
[33]
Kim HJ, Choi GS, Park JS, et al. Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer[J]. Oncotarget, 2017, 8(59): 100724-100733.
[34]
Georgiou P, Tan E, Gouvas N, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis[J]. The Lancet Oncology, 2009, 10(11): 1053-1062.
[35]
Wang JP. Interpretation of the 2020 American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer[J]. Chin J Gastrointest Surg, 2021, 24(1): 27-34.
[36]
武爱文, 詹天成. 直肠癌侧方淋巴结清扫适应证相关国内外指南解读[J]. 中国实用外科杂志, 2018, 38(10): 3.
[37]
Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2017, 28(suppl_4): iv22-iv40.
[38]
Mir ZM, Yu D, Merchant SJ, et al. Management of rectal cancer in Canada: an evidence-based comparison of clinical practice guidelines[J]. Can J Surg, 2020, 63(1): E27-E34.
[39]
中国结直肠癌诊疗规范(2020年版)专家组. 国家卫生健康委员会中国结直肠癌诊疗规范(2020年版)[J].中华胃肠外科杂志, 2020, 23(6): 521-539.
[40]
Ahmadi N, Brown K, Lee P, et al. Is neoadjuvant chemoradiotherapy sufficient in patients with advanced rectal malignancy and positive extra‐mesorectal lateral lymph nodes?[J]. Colorectal Disease, 2020, 22(6): 689-693.
[41]
Williamson JS, Quyn AJ, Sagar PM. Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management[J]. Br J Surg, 2020, 107(12): 1562-1569.
[42]
Malakorn S, Yang Y, Bednarski BK, et al. Who should get lateral pelvic lymph node dissection after neoadjuvant chemoradiation?[J]. Dis Colon Rectum, 2019, 62(10): 1158-1166.
[43]
Kroon HM, Malakorn S, Dudi-Venkata NN, et al. Lateral lymph node dissection after neoadjuvant (chemo)radiotherapy may improve oncological outcomes in Western patients with low rectal cancer[J]. Journal of Clinical Oncology, 2020, 38(4_suppl): 163.
[44]
Ogura A, Konishi T, Beets GL, et al. Lateral nodal features on restaging magnetic resonance imaging associated with lateral local recurrence in low rectal cancer after neoadjuvant chemoradiotherapy or radiotherapy[J]. JAMA Surgery, 2019, 154(9): e192172.
[45]
Chen JN, Liu Z, Wang ZJ, et al. Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer[J]. World J Gastroenterol, 2020, 26(21): 2877-2888.
[46]
刘骞, 王锡山. 直肠癌侧方淋巴结清扫手术指征和清扫范围[J]. 中国实用外科杂志, 2020, 40(3): 311-315.
[47]
Kusters M, Beets GL, Van D, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence[J]. Ann Surg, 2009, 249(2): 229-235.
[48]
Anania G, Davies RJ, Arezzo A, et al. Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients[J]. Inter J Colorec Dis, 2021, 36(11): 2321-2333.
[49]
Yang X, Gu C, Hu T, et al. Is laparoscopic selective lateral lymph node dissection for locally advanced rectal cancer after neoadjuvant chemoradiotherapy safe?[J]. ANZ Journal of Surgery, 2019, 89(11): E492-E497.
[50]
Nakanishi R, Yamaguchi T, Akiyoshi T, et al. Laparoscopic and robotic lateral lymph node dissection for rectal cancer[J]. Surg Today, 2020, 50(3): 209-216.
[51]
Ryu HS, Kim J. Current status and role of robotic approach in patients with low-lying rectal cancer[J]. Ann Surg Treat Res, 2022, 103(1): 1-11.
[52]
Sun Y, Zhang Z, Zhou Y, et al. Fascial space priority approach in laparoscopy: lateral pelvic lymph node dissection for advanced low rectal cancer[J]. Tech Coloproctol, 2020, 24(4): 335-336.
[53]
Sun Y, Lian L, Zhang H, et al. The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study[J]. Wideochir Inne Tech Maloinwazyjne, 2021, 16(2): 312-320.
[54]
王锡山. 腹部无辅助切口经肛门拖出标本的机器人辅助超低位直肠前切除+双侧侧方淋巴结清扫术(王氏入路整块切除法)(附视频)[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(1): 64.
[55]
Wakasugi M, Masuzawa T, Tei M, et al. Single-incision totally extraperitoneal inguinal hernia repair: our initial 100 cases and comparison with conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair[J]. Surg Today, 2015, 45(5): 606-610.
[56]
Masubuchi S, Okuda J, Hamamoto H, et al. Totally extraperitoneal approach to laparoscopic lateral lymph node dissection for patients with recurrent lateral pelvic lymph nodes after rectal cancer surgery: a novel technique—MTEP LLND[J]. Surg Today, 2019, 49(11): 981-984.
[57]
Aytaç E, Özer L, Baca B, et al. Optimizing the personalized care for the management of rectal cancer: a consensus statement[J]. The Turk J Gastroenterol, 2022, 33(8): 627-663.
[58]
Miyakita H, Chan LF, Okada K, et al. Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer and control of lateral lymph node metastasis[J]. BMC Gastroenterology, 2022, 22(1): 334.
[59]
Zhou S, Jiang Y, Liang J, et al. Mesorectal excision with lateral lymph node dissection for mid-low rectal cancer with lateral lymph node metastasis: efficacy and prognostic analysis[J]. World J Surg Oncol, 2022, 20(1): 97.
[60]
刘骞. 直肠癌侧方淋巴结清扫中国临床开展的现状[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(5): 367-371.
[61]
梅世文, 周思成, 梁建伟, 等. 侧方淋巴结转移特征对中低位直肠癌患者预后评估的价值[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(6): 465-473.
[1] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[2] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[3] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[7] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[8] 李明, 屠松, 闫鹏, 钱军, 高鹏程, 许文山, 杨发英, 胡振涛, 单永玮. 应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 603-606.
[9] 李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[10] 赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[11] 吴胜伟, 王志伟, 陈贵进, 刘序, 吴晓翔. 系膜肥厚低位直肠癌患者改良NOSES Ⅰ式手术的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 615-618.
[12] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[13] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[14] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[15] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?