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Prophylactic lateral pelvic lymph node dissection in stage Ⅳ low rectal cancer

World Journal of Clinical Oncology 2017年第5期8卷 412-419页

作者： Hiroshi Tamura Yoshifumi Shimada Hitoshi Kameyama Ryoma Yagi Yosuke Tajima takuma okamura Mae Nakano Masato Nakano Masayuki Nagahashi Jun Sakata Takashi Kobayashi Shin-ichi Kosugi Hitoshi Nogami Satoshi Maruyama Yasumasa Takii Toshifumi Wakai Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Department of Digestive and General Surgery Uonuma Institute of Community MedicineNiigata University Medical and Dental Hospital Department of Surgery Niigata Cancer Center Hospital

AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal *** We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN *** patients had distant metastasis such as liver,lung,peritoneum,and paraaortic *** LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography *** patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 *** evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME *** For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic *** cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.

关键词： Prophylactic lateral pelvic lymph node dissection StageⅣ Low rectal cancer

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