Abstract:

Lower rectal lymphatic drainage and necessity of lateral lymph node dissection for low rectal cancer        WANG Zheng，LIU Qian. Department of Colorectal Surgery，Cancer Hospital，Chinese Academy of Medical Sciences，Beijing 100021，China
Corresponding author：LIU Qian，E-mail：fcwpumch@163. Com
Abstract    There are three lymphatic drainage pathways in lower rectal cancer，including upper，lower and lateral lymphatic drainage pathway. Lateral metastasis of rectal cancer caused by lateral lymphatic drainage pathway is an important cause of pelvic recurrence. Evidence-based medical evidence shows that preoperative concurrent chemoradiotherapy and radiotherapy can not completely kill the lymph node metastasis to the lateral side，and the positive residual rate is more than 60%. For cases with lateral lymph node metastasis after preoperative concurrent chemoradiotherapy，surgical removal of metastatic lymph nodes is the most important treatment，even the only way for patients to achieve long-term survival. Strictly grasping the indications of lateral clearance surgery to improve the positive coincidence rate of pathology，and implementing standard clearance to reduce the incidence of surgical complications through precise operation are expected to bring double benefits of local control and prolonged survival to patients with lateral metastasis of rectal cancer.

Key words: rectal neoplasms, lymph node metastasis, lateral lymph node dissection, lymphatic drainage

摘要：

下段直肠癌已被证明存在向上、向下、侧方3个淋巴引流途径，直肠癌通过侧方淋巴引流途径形成的淋巴结转移是其治疗后盆腔复发的重要原因。大量循证医学证据表明，术前同步放化疗并不能彻底清扫侧方转移淋巴结，其阳性残留比例>60%。对术前同步放化疗后仍然存在侧方淋巴结转移的病例，手术清扫转移淋巴结是最重要的治疗手段，甚至是病人获得长期生存的惟一途径。严格掌握侧方淋巴结清扫指征，提高病理学检查准确率，进行规范的淋巴结清扫，通过精准操作降低手术并发症发生率，有望为直肠癌侧方淋巴结转移病人带来局部复发率的下降和生存延长的双重获益。

关键词: 直肠癌, 淋巴结转移, 侧方淋巴结清扫, 淋巴引流