Abstract：
OBJECTIVE: The significance of lymphadenectomy and its indications in patients with inguinal lymph node metastasis (ILNM) of anorectal adenocarcinoma is unclear. This study aimed to clarify the surgical outcomes and prognostic factors of inguinal lymphadenectomy for ILNM.
METHODS: This study included patients who underwent surgical resection for ILNM of rectal or anal canal adenocarcinoma with pathologically positive metastases between 1997 and 2011 at 20 participating centres in the Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer organized by the Japanese Society for Cancer of the Colon and Rectum. Clinicopathological characteristics and short- and long-term postoperative outcomes were retrospectively analysed.
RESULTS: In total, 107 patients were included. The primary tumour was in the rectum in 57 patients (53.3%) and in the anal canal in 50 (46.7%). The median number of ILNMs was 2.34. Postoperative complications of Clavien-Dindo Grade III or higher were observed in five patients. The 5-year overall survival rate was 38.8%. Multivariate analysis identified undifferentiated histological type (P < 0.001), pathological venous invasion (P = 0.01) and pathological primary tumour depth T0-2 (P = 0.01) as independent prognostic factors for poor overall survival.
CONCLUSIONS: The 5-year overall survival after inguinal lymph node dissection was acceptable, and it warrants consideration in more patients. Further larger-scale studies are needed in order to clarify the surgical indications.
METHODS: This study included patients who underwent surgical resection for ILNM of rectal or anal canal adenocarcinoma with pathologically positive metastases between 1997 and 2011 at 20 participating centres in the Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer organized by the Japanese Society for Cancer of the Colon and Rectum. Clinicopathological characteristics and short- and long-term postoperative outcomes were retrospectively analysed.
RESULTS: In total, 107 patients were included. The primary tumour was in the rectum in 57 patients (53.3%) and in the anal canal in 50 (46.7%). The median number of ILNMs was 2.34. Postoperative complications of Clavien-Dindo Grade III or higher were observed in five patients. The 5-year overall survival rate was 38.8%. Multivariate analysis identified undifferentiated histological type (P < 0.001), pathological venous invasion (P = 0.01) and pathological primary tumour depth T0-2 (P = 0.01) as independent prognostic factors for poor overall survival.
CONCLUSIONS: The 5-year overall survival after inguinal lymph node dissection was acceptable, and it warrants consideration in more patients. Further larger-scale studies are needed in order to clarify the surgical indications.
摘要：
目的：肛门直肠腺癌腹股沟淋巴结转移（ILNM）患者淋巴结清扫术及其指征的意义尚不清楚。本研究旨在阐明ILNM腹股沟淋巴结清扫术的手术效果和预后因素。
方法：本研究纳入了1997年至2011年期间在日本结肠直肠癌学会组织的结肠直肠癌腹股沟淋巴结转移研究小组的20个参与中心接受直肠或肛管腺癌ILNM手术切除并伴有病理阳性转移的患者。回顾性分析临床病理特征和术后短期和长期结果。
结果：总计，共纳入107例患者。原发性肿瘤在57例（53.3％）的直肠和50例（46.7％）的肛管中。ILNM的中位数为2.34。在5例患者中观察到Clavien-DindoIII级或更高的术后并发症。5年总生存率为38.8%。多变量分析确定了未分化的组织学类型（P<0.001），病理性静脉浸润（P=0.01）和病理原发肿瘤深度T0-2（P=0.01）是不良总生存率的独立预后因素。
结论：腹股沟淋巴结清扫术后5年总生存率是可以接受的，值得更多患者考虑。需要进一步的大规模研究以阐明手术适应症。
方法：本研究纳入了1997年至2011年期间在日本结肠直肠癌学会组织的结肠直肠癌腹股沟淋巴结转移研究小组的20个参与中心接受直肠或肛管腺癌ILNM手术切除并伴有病理阳性转移的患者。回顾性分析临床病理特征和术后短期和长期结果。
结果：总计，共纳入107例患者。原发性肿瘤在57例（53.3％）的直肠和50例（46.7％）的肛管中。ILNM的中位数为2.34。在5例患者中观察到Clavien-DindoIII级或更高的术后并发症。5年总生存率为38.8%。多变量分析确定了未分化的组织学类型（P<0.001），病理性静脉浸润（P=0.01）和病理原发肿瘤深度T0-2（P=0.01）是不良总生存率的独立预后因素。
结论：腹股沟淋巴结清扫术后5年总生存率是可以接受的，值得更多患者考虑。需要进一步的大规模研究以阐明手术适应症。
