| Background The lymph node metastasis status of rectal cancer patients is an important factor affecting the prognosis of patients.The NO.253 lymph node is located between the mesenteric artery and the left colic artery.From the perspective of rectal lymph drainage pathway,rectal cancer can be associated with the risk of NO.253 lymph node metastasis.NO.253 lymphadenectomy is based on the recognition of the law of lymph node metastasis in the scope of colon mesentery,and takes the control of lymph node metastasis as the surgical guidance.Its core idea is to pursue the comprehensive cleaning of regional lymph nodes with metastasis risk,so as to achieve the goal of radical treatment.However,it is not clear whether to perform NO.253 lymph node dissection during radical resection of rectal cancer,as well as the timing of performing NO.253 lymph node dissection and its impact on prognosis.Objective To investigate the efficacy and prognostic impact of whether to perform NO.253 lymph node dissection during radical resection of rectal cancer on rectal cancer patients,and analyzing the impact of whether to perform NO.253 lymph node dissection on survival and prognosis of rectal cancer patients at different pathological stages.Methods The clinical data of 168 patients undergoing radical resection of rectal cancer from September 2017 to January 2020 were retrospectively analyzed.According to whether NO.253 lymph node dissection was performed,they were divided into the control group(no dissection)and the observation group(dissection),with 90 cases in the control group and 78 cases in the observation group;According to the standard pathological staging of AJCC rectal cancer TNM Version 8,there were 14 patients with stage I,65 patients with stage II,and 89 patients with stage III.All patients in the observation group received CME+NO 253 Lymphectomy.The patients in the control group all underwent laparoscopic conventional radical resection of rectal cancer.The operation method in the control group was basically the same as that in the observation group.However,during the operation,the integrity of the mesentery was not considered,the root of inferior mesenteric vein was not exposed,the lymph node area in the third station was not cleaned,and the root vessels were not ligated.Before and after operation,the general clinical data of the two groups were observed and compared,including gender,age,ASA grade,differentiation degree,tumor length,etc;Observe and compare the relevant perioperative indicators of the two groups,including postoperative exhaust,hospital stay,number of lymph nodes removed,number of positive lymph nodes,distance between tumor specimen and distal margin,TNM stage,serum carcinoembryonic antigen(CEA)level,etc;The incidence of postoperative complications,cancer specific survival,relapse free survival,total survival(OS)and survival rate were observed.According to ClavienDindo grading standard,the total survival period(OS)refers to the time from the date of pathological/cytological diagnosis to the end of death or the last follow-up.The survival rate is calculated by Kaplan Meier method.In addition,Cox proportional risk model was used to analyze the factors affecting the survival rate of the two groups of patients,Cox regression interaction effect was used to analyze the interaction between the influencing factors,and pathological stages were used as stratification factors to compare the difference in the survival rate of the two groups of patients,and Log rank test was conducted.Results In terms of general data indicators,the operation time of the observation group was significantly longer than that of the control group,with statistical significance(P<0.05).There was no significant difference between the observation group and the control group in terms of bleeding volume,anal exhaust time,and length of hospitalization.At the perioperative index level,the average number of lymph nodes cleaned and the number of positive lymph nodes in the observation group were significantly higher than those in the control group(P<0.05).In terms of complications,there was no death within 30 days after operation in the observation group and the control group,and there were no patients with Grade IV complications;The complication rate in the control group was 21.11%(19 cases),of which 10 cases were grade Ⅰ(6 cases of perineal infection,4 cases of urinary retention),7 cases were grade Ⅱ(3 cases of intraperitoneal hemorrhage,4 cases of respiratory system complications),and 2 cases were grade Ⅲ(all of them were colorectal anastomotic leakage).The complication rate in the observation group was 23.07%(18 cases),of which 9 cases were grade Ⅰ(2 cases of perineal infection,7 cases of urinary retention),6 cases were Grade Ⅱ(2 cases of intestinal obstruction,2 cases of respiratory complications,2 cases of lymphatic leakage),3 cases were Grade Ⅲ(all of them were colorectal anastomotic leakage);In both groups,colorectal anastomotic leakage was improved after emergency transverse colon placement plus pelvic irrigation and drainage;The other types of complications improved after conservative treatment,and there was no significant difference between the two groups(P>0.05).The 3-year survival rate of 168 patients in the two groups was 89.8%during the follow-up period.The 3-year cancer free survival rate of the control group was 94.44%[95%Cl(90.799.7%)],which was higher than 82.47%[95%CI(90.7-99.7%)]of the observation group(P<0.05);The 3-year cancer specific survival rate in the control group was 100%[95%CI(90.7-99.7%)],which was 93.0%[95%CI(83.8-97.2%)]higher than that in the observation group;The 3-year overall survival rate of the control group was 93.9%[95%CI(87.9-99.8%)]higher than that of the observation group(85.9%[95%Cl(77.9-92.8%)],and there was no significant difference between the latter two items.Cox proportional risk model was used to analyze the factors that affect the overall survival rate of the two groups of patients.The single factor results showed that TNM stage,complications,surgical bleeding,whether to relapse,whether to clean NO.253 lymph nodes were related to the survival prognosis of patients(P<0.05).The multi factor COX results showed that whether to relapse,TNM stage,whether to clean NO.253 lymph nodes were independent factors that affected disease free survival prognosis(P<0.05).Cox regression interaction effect was used to analyze the interaction between the factors involved in disease free survival.The results showed that there was interaction between the TNM stage of tumor and whether NO.253 lymph node was cleaned[HR=0.5,P<0.05,95%CI(0.3-0.7)].At the same time,the risk of poor prognosis of patients with TNM stage Ⅲ undergoing NO.253 lymph node cleaning was lower than that of patients not cleaned[HR=0.7,P=0.01,95%CI(0.41.2)].Take pathological stage as stratification factor,compare whether the patients in phase Ⅲ of the two groups receive NO The difference in survival period of 253 showed that the 3-year cumulative survival rate of patients in phase Ⅲ of the control group was 32.8%,and the 3-year cumulative survival rate of patients in phase Ⅲ of the observation group was 60.4%.The difference was statistically significant(P<0.01).Conclusion During the radical resection of rectal cancer,NO.253 lymph node dissection can combine the advantages of CME and NO.253 lymph node dissection.It can thoroughly clean the NO.253 lymph nodes and ensure the integrity of the mesentery and mesangial bed.Under the premise of standardized operation,it can reduce intraoperative bleeding,obtain a high number of lymph nodes,avoid organ damage,and effectively avoid the spread of tumor cells through lymphatic circulation.The clinical efficacy is significant,and the safety is good.At the same time,intraoperative NO.253 lymph node dissection is an important factor affecting the prognosis of patients undergoing rectal cancer radical surgery,which interacts with the TNM staging of the tumor.The implementation of NO.253 lymph node dissection during radical resection of rectal cancer can significantly improve the postoperative survival rate of stage Ⅲ patients.For patients in T3-4 staging with highly suspected lymph node metastasis,intraoperative NO.253 lymph node dissection is recommended. |
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