Re-evaluation the feasibility of lateral lymph node dissection in radical resection of low rectal cancer: report of 20 cases

doi:10.3877/cma.j.issn.2095-3224.2023.02.013

Abstract

Abstract:

Objective

To study the significance of lateral lymph node dissection in low rectal cancer surgery and explore the accuracy of preoperative imaging data used to evaluate whether lateral lymph node metastasis combined with the practice of Jiangsu Cancer Hospital.

Methods

The possible reasons for the negative pathology after lateral lymph node dissection were analyzed for the patients with lateral lymph node metastasis highly suspected by preoperative imaging examination in our hospital.

Results

There was no metastasis in lateral lymph nodes, and the metastasis rate in mesenteric lymph nodes was 70%. The metastasis rate of well-differentiated adenocarcinoma was 30%, and the metastasis rate of moderately poorly differentiated was 85.7%.

Conclusion

It is difficult to diagnose lateral lymph node metastasis and guide surgical dissection only by imaging evaluation of lymph node size and morphology before surgery, and its accuracy is questionable. The incidence of lateral lymph node metastasis is very low, lateral lymph node dissection should be performed with great caution in patients with low rectal cancer. In addition to a comprehensive imaging evaluation, previous medical history and other conditions of patients should be full considered before surgery. MDT could be conducted to aid surgical decision-making if necessary.

Key words: Rectal neoplasms, Total mesorectal excision, Lateral lymph node dissection

Peng Shao, Chengshuai Si, Yuepeng Cao, Xin Zhou, Xu Zhang, Dongzheng Li. Re-evaluation the feasibility of lateral lymph node dissection in radical resection of low rectal cancer: report of 20 cases[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(02): 167-171.

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References 20

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病例	性别	年龄（岁）	病理分化类型	术后分期	肿瘤切缘	脉管及神经侵犯	淋巴结转移位置	肿瘤下缘距肛门距离（cm）	手术方式
1	男	42	中-低分化腺癌	T3N0M0	阴性	是	无转移	8	直肠前切除术
2	男	55	高分化腺癌	T2N0M0	阴性	否	无转移	5	直肠前切除术+预防性回肠造口术
3	男	60	高分化腺癌	T2N0M0	阴性	是	无转移	1	腹会阴联合直肠切除术
4	男	58	高分化腺癌	T2N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
5	男	54	高分化腺癌	T2N0M0	阴性	否	无转移	2	腹会阴联合直肠切除术
6	男	61	高分化腺癌	T2N0M0	阴性	否	无转移	7	直肠前切除术
7	男	60	高分化腺癌	T2N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
8	男	56	高分化腺癌	T2N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
9	男	43	高分化腺癌	T3N0M0	阴性	是	无转移	1	腹会阴联合直肠切除术
10	男	48	高分化腺癌	T3N0M0	阴性	否	无转移	6	直肠前切除术
11	男	57	高分化腺癌	T3N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
12	男	62	高分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
13	男	67	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	1	腹会阴联合直肠切除术
14	男	66	中-低分化腺癌	T2N2M0	阴性	是	肠系膜下血管根部	8	直肠前切除术
15	男	44	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	5	直肠前切除术+预防性回肠造口术
16	男	68	低分化腺癌	T3N1M0	阴性	否	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
17	女	46	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	1	腹会阴联合直肠切除术
18	女	43	高分化腺癌	T3N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	3	直肠前切除术+预防性回肠造口术
19	女	65	高分化腺癌	T2N1M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	4	直肠前切除术+预防性回肠造口术
20	女	68	低分化腺癌	T3N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	6	直肠前切除术

病例	性别	年龄（岁）	病理分化类型	术后分期	肿瘤切缘	脉管及神经侵犯	淋巴结转移位置	肿瘤下缘距肛门距离（cm）	手术方式
1	男	42	中-低分化腺癌	T3N0M0	阴性	是	无转移	8	直肠前切除术
2	男	55	高分化腺癌	T2N0M0	阴性	否	无转移	5	直肠前切除术+预防性回肠造口术
3	男	60	高分化腺癌	T2N0M0	阴性	是	无转移	1	腹会阴联合直肠切除术
4	男	58	高分化腺癌	T2N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
5	男	54	高分化腺癌	T2N0M0	阴性	否	无转移	2	腹会阴联合直肠切除术
6	男	61	高分化腺癌	T2N0M0	阴性	否	无转移	7	直肠前切除术
7	男	60	高分化腺癌	T2N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
8	男	56	高分化腺癌	T2N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
9	男	43	高分化腺癌	T3N0M0	阴性	是	无转移	1	腹会阴联合直肠切除术
10	男	48	高分化腺癌	T3N0M0	阴性	否	无转移	6	直肠前切除术
11	男	57	高分化腺癌	T3N0M0	阴性	否	无转移	4	直肠前切除术+预防性回肠造口术
12	男	62	高分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
13	男	67	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	1	腹会阴联合直肠切除术
14	男	66	中-低分化腺癌	T2N2M0	阴性	是	肠系膜下血管根部	8	直肠前切除术
15	男	44	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	5	直肠前切除术+预防性回肠造口术
16	男	68	低分化腺癌	T3N1M0	阴性	否	肠上+肠旁淋巴结（瘤旁）	2	腹会阴联合直肠切除术
17	女	46	低分化腺癌	T4aN2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	1	腹会阴联合直肠切除术
18	女	43	高分化腺癌	T3N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	3	直肠前切除术+预防性回肠造口术
19	女	65	高分化腺癌	T2N1M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	4	直肠前切除术+预防性回肠造口术
20	女	68	低分化腺癌	T3N2M0	阴性	是	肠上+肠旁淋巴结（瘤旁）	6	直肠前切除术

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