应重视中低位直肠癌选择性侧方淋巴结清扫术的开展  

Pay attention to the selective lateral pelvic lymph node dissection in mid-low rectal cancer

作　　者：孟文建[1] 王自强[1] 

机构地区：[1]四川大学华西医院胃肠外科,成都610041

出　　处：《中华胃肠外科杂志》2017年第3期258-262,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：四川省科技厅科技支撑项目（2016SZ0043）

摘　　要：侧方淋巴转移是中低位直肠癌重要的转移方式，也是导致术后局部复发的重要原因。近年来，东西方国家对于侧方淋巴结转移的诊断、临床意义、治疗和预后存在争议。西方国家认为，侧方淋巴结转移是全身转移，术前新辅助放化疗能有效杀灭可能存在的侧方转移淋巴结，因而多数主张在行新辅助治疗后单纯行全直肠系膜切除手术，不需要行侧方淋巴结清扫。而东方国家、尤其是日本对侧方淋巴结清扫术持积极态度，他们认为侧方淋巴结转移是区域转移，术前可疑存在的侧方转移性淋巴结并不能彻底被新辅助放化疗消灭，新辅助放化疗后有选择性地施行侧方淋巴结清扫可望进一步提高此类患者疗效。因此，亟需大宗病例前瞻性研究以改进侧方淋巴结清扫和新辅助治疗的选择标准，防止过度治疗。结合最新的影像学手段，针对怀疑侧方淋巴结转移的病例，在新辅助放化疗后积极开展选择性侧方淋巴结清扫术，有望降低中低位直肠癌患者的局部复发率，改善其长期生存。Lateral pelvic lymph node metastasis is an important metastatic mode and a major cause of locoregional recurrence of mid-low rectal cancer. Recently, there is an East-West discrepancy in regard to the diagnosis, clinical significance, treatment and prognosis of lateral pelvic lymph node metastasis. In the West, lateral nodal involvement may represent systemic disease and preoperative chemoradiotherapy can sterilize clinically suspected lateral nodes. Thus, in many Western countries, the standard therapy for lower rectal cancer is total mesorectal excision with chemoradiotherapy, and pelvic sidewall dissection is rarely performed. In the East, and Japan in particular, however, there is a positive attitude in regard to lateral pelvic lymph node dissection （LPND） . They consider that lateral pelvic lymph node metastasis is as regional metastasis, and the clinically suspected lateral nodes can not be removed by neoadjuvant chemoradiotherapy. The selective LPND after neoadjuvant chemoradiotherapy may be found to be promising treatment for the improvement of therapeutic benefits in these patients. Therefore, the large-scale prospective studies are urgently required to improve selection criteria for LPND and neoadjuvant treatment to prevent overtreatment in the near future. Selective LPND after neoadjuvant treatment based on modern imaging techniques is expected to reduce locoregional recurrence and improve long-term survival in patients with mid-low rectal cancer.

关 键 词：中低位直肠癌 侧方淋巴结清扫术 新辅助放化疗 

分 类 号：R735.37[医药卫生—肿瘤]