Clinical Study On Lymph Node Metastasis And Nerve Protection Of Sigmoid Cancer

In the radical surgery to the sigmoid colon cancer the extent of resection of lymphatic nodes and protection to the automocim cong posterior to the peritoneum are to important factors that affect the recuurence of the turmor survival rate and presence and absence of sexual dysfunction in male patients. Much literature have revealed that expand radical surgery to the sigmoid colon cancer in developed stage is the directly releated to the erectile dysfunction in male. So to select the resection extent of lymphatic nodes is a delimma to surgeons. The following factors are vital to the survival rate and quality of life of patients suffered Sigmoid colon cancer: first, to familiar with the metastasis rules and distribution of lymphatic vascular and nerval structures posterior to the peritoneum; second, to select proper extent of resection to lymphatic nodes and to protect the automocim cong posterior to the peritoneum.The cohort in this study was constructed by 36 patients suffered to Sigmoid colon cancer, who were treated in our hospital during January 2005 and March 2007. The patients that were in the stage of Dukes D or used to received Radiotherapy or were treated by emergent surgery due to acute ileus or with recurrent tumor. There were 18 males and 18 females, and the age ranged from 25 to 82 years with an average of 57.3 years.The diagnosis of all of the 36 patients was confirmed by the pre-operation examinations. Routine pre-operation preparation was done to all patients including intestine preparation, intra-vein nutrition to correct anemia Hypoproteinemia hypertension and Hyperglycemia. Total anesthesia and open operation were applied to all the patients. The method was D3 radical surgery. The TNM stage was established by the findings during operation. During dissection to the root of the sigmoid colon and ligation of mesenteric vascular the Abdominal aortic plexus and Cong on the fuselage retroperitoneal autonomic nerve was protected. Lymphatic nodes were detected any biopsy was done. The lymphatic nodes are N1 of para-tumur, N2 of para-sigmoid colon vessels, N3 of root of Mesenteric vessels, those along the long axis of the intestine with the distance from 5cm to 10cm and those beyond 10cm. TheΧ2 statistic method was applied to evaluated the difference between the lymphatic nodes metastasis rate and the sex and age of the patients, the size of the tumor, the infiltration extent in the wall of the intestine, the depth of infiltration, the pathological classification (P<0.05 was defined as significant difference).The results revealed that 15 of all the 36 patients had lymphatic metastasis and the metastasis rate was 41.7%. The overall number of the lymphatic nodes undergone biopsy 306, and averaged 8.5 to each patient (ranged 6 to 13). 49 lymphatic nodes had metastasis and the rate was 16%. Skipping metastasis was detected in 3 patients, which were N1 (-)-N2 (+)-N3 (-) in 2 cases and N1 (+)-N2 (-)-N3 (+) in 1 case. Among the 15 cases with metastasis 12 cases were central directed lymphatic metastasis and 3 cases were along the long axis of the intestine. The rates were 33.3% and 8.3% respectively. The two directions of metastasis were found to be with statistic significant difference byΧ2 evaluation. The metastasis rates of male and female were 33.3% and 50.0% respectively, and significant difference was not found byΧ2 evaluation as to this factor. The lymphatic nodes metastasis rates of different age groups were 80% 38.5% and 33.3% respectively, and significant difference were found among these groups byΧ2 evaluation. The lymphatic metastasis rates of different tumor size groups were 54% and 60% respectively, and there was not significant difference between these two groups as weighted byΧ2 evaluation. As to the metastasis rates of different intestinal wall infiltration groups, there was no significant difference among the four groups weighted byΧ2 evaluation. As to the relationship between gross classification and metastasis rates, they were 40% in bulging type group, 43.1% in infiltrating type group and 40% in ulcer type group, and significant difference was not found among these three groups as calculated byΧ2 evaluation. So difference was not thought to exist among these groups.As to the four groups divided by the extent of infiltrating depth in the wall of intestine there was significant difference between them when evaluated by metastasis rate using multi-sampleΧ2 evaluation. There was significant difference among different pathological groups calculated byΧ2 evaluation. There was no significant difference among the groups of Mucinous adenocarcinoma, Squamous cell carcinoma and undifferentiated carcinoma when weighted by multi-sampleΧ2. The situation of post-operation complications is as follows. There was 1 case of incision fistula but no bleeding and narrowness of Anastomosis, and the occurrence rate was 2.8%. There was 1 case of Adhesive Ileus, which was eased after 5 days of non-operation treatment. 4 cases had defecation dysfunction with the main symptom of water like stool and more times than usual. They were cured during the period of 2 weeks to 1 month. Fat Liquefying was encoutered in 5 patients, whose incision had delayed union. Follow up was done to all of the 36 patients 6 months after operation, with no one lost to follow up, and there was 0 case of recurrence, 1 case of liver metastasis, who was a patient in the stage of Dukes C, 0 case of incision cultivation. According to the results of the questionair performed to the 18 male patients on erectile function, there was no erectile disfunction after operation.The following conclusions are drawn from this study: (1) The patients suffered from Sigmoid colon cancer should be treated by the radical surgery of D3. (2) The resecting extent of intestine in sigmoid colon cancer should be beyond 20cm proximally and 10cm distally, and when the tumor lies on the border of Rectal and Sigmoid colon, the resecting point should move distally enough. (3) There is no relationship between the lymphatic metastasis rate and the sex of the patient, the size of the tumor, the extent of infiltrating on the wall of the intestine and the gross classification (P>0.05). While there is close relationship between the metastasis rate and the infiltrating depth in the wall of the intestine, pathological classification and age of the patient (P<0.05). (4) The ligation of the Mesenteric vessels should be done at the root of it to facilitate the operation, removal of tumor and protection of autonomic nerve, which therefore should become the routine of radical surgery. (5) Leaving the Celiac plexus autonomic nerve intact during operation of radical surgery to sigmoid colon cancer can avoid harming the erectile function of male patients, which can improve the life quality of them.