| Objective:To analyse the clinical risk factors of lymph node metastasis in inferior mesenteric artery root of rectal cancer,as to guide the lymph node dissection of inferior mesenteric artery root during surgery and determine the effective surgical plan。Methods:A retrospective analysis was performed on data from 75 patients with CRC that underwent radical surgery at China-Jupan Union Hosspital of Jilin University between Auguest 2019 and June 2022.All patients underwent surgery to resect the tumors,lymph node dissection at the root of the inferior mesenteric arteries and the NO.253 lymph node were sent for pathological examination singly.Collected patients` age、BMI、tumor occupied the circumferential diameter of intestinal canal、the distance from the lower margin of tumor to anal margin、preoperative serum CEA levels、preoperative serum CA19-9 levels、preoperative serum CA15-3 levels、preoperative serum CA242 levels、the situation of rectal cancer obstruction、histological typing of rectal tumours、tumor diameter、T stage、N stage、the degree of differentiation in rectal cancer、the situation of tumor thrombus、the situation of tumor involving nerves、total numbers of lymph nodes and positive lymph nodes and results for mismatch repair proteins and then independently tested as control variables.The data were analyzed by SPSS 26.0 software.The single factor analysis was performed by χ2 test with p = 0.05 as a test level.Result:A total of 75 cases were included in this study,five patients among them had lymph node metastases around the root of the inferior mesenteric artery,and the metastatic rates were 6.6%.A total of 210 lymph nodes were dissected from the 75 patients,9 lymph nodes of which presented lymph node metastasis by postoperative pathology.There were 50 male patients,3 patients among them with metastasis,and there were 25 female patients,2 patients among them with metastasis,the metastasis rates were 6% and 8% respectively(χ2=0.107,P=0.743)。There were 46 patients with age ≥ 60 years old,3 patients among them with metastasis,and 29 patients with age<60 years old,2 patients among them with metastasis,the metastasis rates were6.5% and 6.8% respectively(χ2=0.004,P=0.949)。There were 58 patients with BMI≥ 20 kg/㎡,4 patients among them with metastasis,and 17 patients with BMI<20kg/㎡,1 patient among them with metastasis,the metastasis rates were 6.9% and5.9% respectively(χ2=0.022,P=0.883)。There were 9 patients with diabetes history,1 patient among them with metastasis,and there were 66 patients without diabetes history,4 patients among them with metastasis,the metastasis rates were11.1% and 6.1%respectively(χ2=0.325,P=0.569)。There were 44 patients with tumors occupying more than 1/2 of the intestinal cavity,3 patients among them with metastasis,and 15 patients with tumors occupying less than 1/2 of the intestinal cavity,1 patient among them with metastasis,the metastasis rates were 6.7% and6.8% respectively(χ2=0.006,P=0.997)。There were 26 patients with the distance from the lower margin of the tumor to the anal margin ≥10cm,3 patients among them with metastasis,and 43 patients with the distance from the lower margin of the tumor to the anal margin <10cm,2 patient among them with metastasis,the metastasis rates were 11.5% and 4.7% respectively(χ2=1.701,P=0.427)。There were 1 patient of preoperative obstruction,0 among them with metastasis,and 74 patients of preoperative non obstruction,5 patients among them with metastasis,the metastasis rates were 0% and 6.8% respectively(χ2=0.072,P=0.788)。There were 36 patients with ulcerative type,3 patients among them with metastasis,14 patients with eminence type,1 patient among them with metastasis,and 0 patient with infiltrative type,the metastasis rates were 8.3%,7.1%,and 0% respectively(χ2=0.452,P=0.798)。There were 32 patients with CEA ≥ 5ng/ml,1 patient among them with metastasis,and 37 patients with CEA<5ng/ml,4 patients among them with metastasis,the metastasis rates were 3.1% and 10.8% respectively(χ2=2.095,P=0.351)。There were 4 patients with CA19-9≥37U/ml,1 patient among them with metastasis,and 65 patients with CA19-9 < 37U/ml,4 patients among them with metastasis,the metastasis rates were 25% and 8.7% respectively(χ2=2.617,P=0.270)。There were 8 patients with CA15-3≥6U/ml,0 patient among them with metastasis,and 29 patients with CA15-3 < 6U/ml,2 patients among them with metastasis,the metastasis rates were 0% and 6.9% respectively(χ2=0.666,P=0.717)。There were 5 patients with CA242≥20U/ml,1 patient among them with metastasis,and 63 patients with CA242<20U/ml,4 patients among them with metastasis,the metastasis rates were 20% and 6.3% respectively(χ2=1.939,P=0.379)。There were28 patients with tumor diameter≥5cm,3patients among them with metastasis,and 46 patients with tumor diameter<5cm,2 patients among them with metastasis,the metastasis rates were10.7% and 4.3% respectively(χ2=1.206,P=0.547)。There was1 patient in stage T1,none with metastasis,12 patients in stage T2,none with metastasis,59 patients in stage T3,4 patients among them with metastasis,and 2patients in stage T4,1 patient among them with metastasis,the metastasis rates were0%,0%,6.8% and 50% respectively(χ2=7.037,P=0.134)。There was 31 patient in stage N0,none with metastasis,26 patients in stage N1,1 patient among them with metastasis,18 patients in stage N2,4 patients among them with metastasis,the metastasis rates were 0%,3.8% and 22.2% respectively(χ2=9.547,P=0.008)。There were 0 well-differentiated patient,49 moderately differentiated patients,3 patients among them with metastasis,25 poorly differentiated patients,2 patients among them with metastasis,and 0 undifferentiated patient,the transfer rates were 0%,4.1%,12%and 0% respectively(χ2=1.741,P=0.419)。There were 31 patients with vascular tumor thrombus invasion,5 patients among them with metastasis,and 44 patients with non vascular tumor thrombus invasion,none with metastasis,the metastasis rates were 16.1% and 0% respectively(χ2=7.604,P=0.006)。There were 17 patients with nerve involvement,3 patients among them with metastasis,58 patients without nerve involvement,and 2 patients among them with metastasis,the metastasis rates were17.6% and 3.4% respectively(χ2=4.260,P=0.039)。There were 2 patients with mismatch repair protein deficiency,none with metastasis,and 73 patients with normal expression of mismatch repair protein,5 patients among them with metastasis,and the metastasis rates were 0% and 6.8% respectively(χ2=0.147,P=0.702)。Conclusion: Cancer thrombus invasion、nerve involvement are risk factors for lymph node metastasis at the root of the inferior mesenteric artery,and the higher the N stage,the greater the probability of lymph node metastasis at the root of the inferior mesenteric artery.Clinically,the above factors can be combined to further evaluate the status of NO.253 lymph node metastasis in rectal cancer patients before surgery,so as to provide a reference for the dissection of the lymph node at the root of the inferior mesenteric artery. |
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