Cerrahi yöntemin kolorektal kanser cerrahisinde diseke edilen lenf nodu özellikleri üzerine etkisi

Amaç: Laparoskopik kolorektal cerrahinin artmasıyla birlikte laparoskopik ve açık cerrahiyi karşılaştıran bir çok çalışma yapılmaya başlanmıştır. Karşılaştırma parametrelerinden bir taneside yeterli sayıda lenf nodunun çıkartılıp çıkartılmadığıdır. Yerinde bir kolorektal kanser evrelemesi için kılavuzların tavsiyesi 12’den aşağı lenf nodu çıkartılmaması gerektiği yönündedir. Literatürde kolorektal rezeksiyonların yalnızca %48’inde bu sayıya ulaşıldığı bildirilmiştir. Biz çalışmamızda laparoskopik kolorektal cerrahi ile açık cerrahinin lenf nodu diseksiyonu sayısı ve özellikleri üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Hastanemiz genel cerrahi kliniğinde Ocak 2011-Ocak 2013 tarihleri arasında kolorektal kanser cerrahisi uygulanan hastalara ait dosyalar retrospektif olarak tarandı. Hastalar açık cerrahi ve laparoskopik cerrahi uygulananlar olarak iki gruba ayrıldı. Hastaların yaş, cins, ameliyat öncesi tanıları, tümör evreleri, yapılan ameliyatın şekli, çıkarılan lenf nodu sayısı ve lenf nodlarında metastazın olup olmadığı kaydedildi. Gruplar lenf nodu özellikleri açısından karşılaştırıldı.Bulgular: Toplamda 55 hastaya kolorektal kanser cerrahisi uygulanmıştı. Bunların 17 (%31)’sine laparoskopik, 38 (%69)’ ine açık kolon cerrahisi uygulanmıştı. Hastaların yaş ortalaması 63,9±12,9 idi. Gruplar yaş, cinsiyet ve tümör evresi yönünden benzerdi. Laparoskopik cerrahide çıkartılan lenf nodu sayısı ortalama 17,2±4,8 iken açık cerrahide bu oran 18,7±5,2 idi. Bu fark istatistiksel olarak benzerdi (p>0,05). Metastatik lenf nodları değerlendirildiğinde ise iki grup arasında fark yoktu. Sonuç: Çıkartılan lenf nodları bakımından laparoskopik cerrahi açık cerrahi kadar etkindir. Yerinde cerrahi evreleme yapılabilmesi için cerrah ve patologun beraber çalışması gerekmektedir.

Anahtar Kelimeler:

Laparoskopik cerrahi, lenf nodu, kolorektal cerrahi

The effect of the surgical method on the number of disected lymph nodes in colorectal cancer surgery

Aim: By the dissemination of laparoscopic colorectal surgery there are many studies comparing the laparoscopic and open surgery. One of the parameters that are compared is the dissected lymph node number. The guidelines offer that there should be a minimum number of 12 lymph nodes for the staging of colorectal cancer. It is reported that only 48% of the resections achieve this number. In this study aims to compare the number of lymph nodes resected in laparoscopic and open colorectal cancer surgery.Material and Method: The files of the patients who had colorectal surgery in our clinic in between January 2011 and January 2013 were retrospectively evaluated. The patients were divided into two groups as laparoscopic and open surgery groups. Patients’ age, gender, preoperative diagnosis, tumor stage, surgical method, resected lymph node number and positivity of lymphatic metastasis were recorded. The groups were compared according to lymph node features.Results: There were 55 patients with colorectal surgery [17(31%) laparoscopic and 38(69%) open surgery]. The mean age of the patients was 63.9±12.9, the groups were similar in terms of age, gender and the tumor stage. The mean dissected lymph node number was 17.2±4.8 for laparoscopy group and 18.7±5.2 for open surgery group. This difference was not statistically significant (p>0.05). There is no difference in between the groups in terms of metastatic lymph node numbers. Conclusion: Laparoscopic surgery is as effective as open surgery in term of harvested lymph nodes. For the reliable tumor staging the surgeon and the pathologist should work together.

Keywords:

Laparoscopic surgery, lymph node, colorectal surgery,

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