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좌측 결장암에서 하장간막 기시부 림프절 전이

IMA-origin Lymph Node Metastasis in Left Colon Cancer

대한대장항문학회지 2008년 24권 5호 p.380 ~ 385
이재훈 ( Lee Jae-Hoon ) - 영남대학교 의과대학 외과학교실

김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실
김현진 ( Kim Hyun-Jin ) - 영남대학교 의과대학 외과학교실
정상훈 ( Jung Sang-Hun ) - 영남대학교 의과대학 외과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실
황종성 ( Hwang Jong-Sung ) - 영남대학교 의과대학 외과학교실

Abstract


Purpose: Although an extended colon resection with high ligation of the inferior mesenteric artery (IMA) generally has been recommended as curative surgery for advanced left colon cancer (LCC), it shows little or no survival advantage over segmental resection with low ligation of IMA. The present study is to determine the risk factors associated with IMA-origin lymph-node (LN) metastasis and to clarify the implication of IMA-origin LN metastasis.

Methods: We examined the clinicopathological results of 200 cases of LCC. LN dissection was performed as follows: D2 en-bloc resection of the primary tumor, IMA-origin LN dissection, and paraaortic LN dissection.

Results: The incidence of IMA-origin LN metastasis of LCC was 4.5% (9 cases), and all cases involved sigmoid colon cancer. The independent risk factors of IMA-origin LN metastasis were four or more regional LN metastases (hazard ratio: 16.51, 95% confidence interval: 1.60∼164.12) and a preoperative CEA level of greater than 6 ng/ml of (hazards ratio: 6.63, 95% confidence interval: 1.06∼41.32). The incidence of IMA-origin LN metastasis among stage IIIC patients was 26.7%. Five of the 9 (55.6%) cases of IMA-origin LN metastasis had a concomitant paraaortic LN metastasis.

Conclusions: The incidence of IMA-origin LN metastasis among patients with LCC was low; however, IMA-origin LN metastasis should be considered as a systemic metastasis. J Korean Soc Coloproctol 2008;24:380-385

키워드

좌측 결장암;하장간막동맥 기시부;림프절 전이
Left colon cancer;IMA origin;Lymph node metastasis
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