The Clinical Analysis Of Lymph Node Metastasis Regularities In Right-sided Colon Carcinoma

Objective:To investigate the rule of lymph node metastasis in right colon cancer and analyze the related factors of lymph node metastasis,so as to provide reference for the selection of lymph node dissection and surgical methods.Methods:The clinical data of 390 consecutive patients with right colon cancer from January 2010 to December 2017 were analyzed retrospectively.The right colon was divided into ileocecal group,ascending colon group and hepatic flexure group according to the 7th edition of the Japanese Statute of Colorectal Cancer.The distribution of positive lymph nodes was analyzed.Degree of lymph node metastasis(LNR)=(number of metastatic lymph nodes/total number of lymph nodes)100%;Lymph node metastasis rate=(number of positive lymph nodes/total number of cases)100%Results:According to the depth of right colon invasion,only N1 lymph node metastasis was found in both T1 and T2,which was 11.1%and 14.3%respectively.N1,N2,and N3 in T3 and T4 groups all had lymph node metastasis,with metastasis rates of 38.2%,11.6%,and 7.9%;and 63.9%,26.5%,and 25.3%,respectively.2.Lymph node metastasis rate in ileocecal group No.202 was significantly higher than No.222rt(12.0%vs 0),the difference was statistically significant(?~2=11.699,p=0.000).No.203 was significantly higher than No.223(6.5%vs 0),the difference was statistically significant(?~2=6.202,p=0.014).No.203(2.2%),No.213(2.2%),No.223(3.0%),compared between groups(?~2=0.415,p=0.375),the difference was not statistically significant.No.203(0%),No.213(6.7%),No.223(5.9%),compared between groups(?~2=0.065,p=0.500),the difference was not statistically significant.No.212 and No.222rt was similar(4.4%vs 6.7%),and No.213 was similar to No.223 were similar(6.7%vs 5.9%),and the differences were not statistically significant(?~2=0.635,P=0.298;2=0.063,P=0.500).3.Analysis of related factors:Gross type,differentiation,depth of invasion were associated with the rate of total lymph node metastasis in right colon cancer(p<0.05).4.In No.206 group,lymph nodes were detected in 181 cases,lymph node metastasis in 4 cases,metastasis rate was 2.2%(4/181),total number of lymph nodes was 432,metastatic lymph nodes were 5,and metastasis rate was 1.2%(5/432);terminal ileum lymph node metastasis was found in 9 cases,metastasis rate was 2.5%(9/362),ileocecal group was 5 cases,and ascending colon group was 4 cases.Conclusions:1.The depth of tumor invasion,tumor differentiation and histological type are independent risk factors of lymph node metastasis of right colon cancer.2.T2/T1right colon cancer can be treated with D2 or D2+radical resection,T3+T4 ascending colon cancer or hepatic flexure cancer of the colon should undergo D3 radical resection and be removed together with No.206 lymph nodes.206 lymph nodes.3.In patients with T3/T4 ileocecal cancer or ascending colon cancer,when radical right hemicolectomy is performed,mesentery lymph node dissection within 10 cm of the terminal ileum should also be emphasized to avoid tumor recurrence caused by residual metastatic lymph nodes.