リンパ節転移状況からみた右側結腸癌に対する切除範囲の検討  [in Japanese] Modified Surgery for Right-Sided Colon Cancer : Lymph Node Metastasis Dictates Its Suitability  [in Japanese]

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Abstract

右側結腸癌のうち右半結腸切除術かつD2以上の郭清を行った治癒切除例104例を対象とし,リンパ節転移状況を占拠部位別に検索し切除範囲について考察した.1)腸管軸方向転移は腫瘍径8cm,10cmの2例を除き5cm以内であった.2)盲腸癌では腫瘍径8cmの1例を除き回結腸動脈に沿う転移であった.3)近位上行結腸癌では回結腸動脈に沿うリンパ節転移に留まっていた.4)中位上行結腸癌では腫瘍径にかかわらず広範囲に転移がみられた.5)遠位上行結腸癌では腫瘍径8.5cmの症例でNo.223に転移を認め,他は右結腸動脈に沿う転移であった.6)右側横行結腸では,腫瘍径10cmの症例に広範な転移を認めたが,回結腸動脈への転移例はなかった.以上より腫瘍径8cm未満の症例において盲腸,近位上行結腸癌に対しては回盲部切除術,右側横行結腸,上部上行結腸癌対しては回盲部温存術式でも根治性は保たれるものと考られた.

The distribution of metastatic lymph nodes in 104 cases with right-sided colon cancer, in which curative resection had been performed, was studied. Lymph node (LN) metastasis along the bowel was not evident at a distance of more than 5 cm from the tumor, with the exception of two cases in which the tumor measured more than 8 cm in diameter. In cecal colon cancer, LN metastasis was recognized only in the nodes along the ileocolic artery, except for one case in which the tumor measured 8 cm in diameter, and in proximal ascending colon cancer, it was also recognized only in the nodes along the ileocolic artery. In mid-ascending colon cancer, LN metastasis was recognized extensively, regardless of tumor size. In distal ascending colon cancer, LN metastasis was recognized only in the nodes along the right colic artery, except for one case in which the tumor measured 8.5 cm in diameter, whereas in right-sided transverse colon cancer, it was not recognized in any nodes along the ileocolic artery, except for one case in which the timor measured 10 cm in diameter. These findings suggest that ileocecal resection may provide sufficient radicality for both cecal colon and proximal ascending colon cancers, and that surgical preservation of the ileocecal junction may be feasible for both proximal ascending colon and right-sided transverse colon cancers, except for cases in which the tumor measures more than 8 cm in diameter.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(4), 189-194, 2002-04-01

    The Japan Society of Coloproctology

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