NGHIÊN CỨU TỶ LỆ DI CĂN HẠCH CHẬU BÊN SAU PHẪU THUẬT ĐIỀU TRỊ UNG THƯ TRỰC TRÀNG THẤP

Abstract

Objective: To determine the rate and related factor of LPLNM after radical surgery. Subjects and Methods: We conducted a retrospective cohort study using data from 115 patients with low RC following radical treatment in University Medical Center of Ho Chi Minh city from January 2016 to May 2021. Patients were followed up and received computed tomography scan (CT scan) or pelvic magnetic resonance imaging (MRI) periodically. Diagnostic criteria for LPLNM on CT scan include short axis diameter ³ 7mm for lymph nodes along the internal iliac artery and obturator artery, or ³ 10 mm for common iliac artery and external iliac artery. Results: The average age was 56.07 (range, 27-88 years.), 60% were male. The rate of LPLNM was 10.4% during the median 28-month follow-up, accounting for 75% of PR. The most common locations for LPLNM are the internal iliac artery (45.8%) and obturator artery (33.3%). The LPLNM free survival rate at 24 months was 94,1%. Factors related to LPLNM include tumor size ≥ 30 mm (p=0,049), distance from the lower edge of the tumor to the anal verge > 70 mm (p=0,014), positive circumferential resection margin (CRM+) (p=0,007), mucinous adenocarcinoma histology type (p=0,024), pTNM stage (p=0,009), postoperative CEA level > 5 ng/ml (p=0,049), and APR surgery (p=0,005). Conclusions: LPLNM is a common site of pelvic recurrence. Patients with factors related to LPLNM need to be closely monitored and should consider early pelvic lymph node dissection surgery if metastasis is suspected during postoperative follow-up.