OS is over 5 years!How to choose the treatment plan for post -peritoneal lymph node metastasis?

Author:Cancer Channel of the Medical Time:2022.08.03

*For medical professionals for reading reference

How to safely remove the "time bomb" after the peritoneum?

The metastasis of colorectal cancer is mainly through lymphatic metastasis, which can be metastasized to the post -obsecum lymph nodes. However, its anatomy position is deep, the distribution range is wide, there are many neighbor tissues and organs, and the surgical exposure is difficult, and the risk of damage is high. And there are still many controversy in the prognosis of postcard lymphatic cleansing to improve the prognosis of colorectal cancer.

In this issue, the "Classification of Cases" was shared by Shi De Bing, deputy chief physician of the Cancer Hospital affiliated to Fudan University, brought 1 case of colon cancer.

Basic information

Patient, male, 67 years old.

In May 2017, for "7 months of blood in the stool".

Previous history: 5 years of high blood pressure and 3 years of coronary heart disease, good drug control.

Tumor marks: CEA 66.32ng/ml, CA724 27.50U/ml

Enhancement of the abdominal cavity CT: Irregular enhancement of the colonic intestinal segment, rough and rough plasma surface, and more enhanced lymph nodes around

Diagnosis basis: medical history+elevated tumor marker+imaging abdomen pelvic CT examination results

Clinical diagnosis of sigmal colon cancer (CT3N1M0)

Treat

In May 2017, laparoscopic high -level rectal resection

Seeing during the operation: The primary tumor is located 15cm in the reflection, and the lymph nodes are enlarged in the intestinal membrane.

Postoperative pathology: medium -divide adenocarcinoma, affecting the membrane layer of intestinal wall, LNM 4/18

ask

Based on the above information, how should I choose the treatment plan?

(Please think first 1 minute before checking down)

Postoperative Auxiliary Chemotherapy 8 Tour: XELOX solution

First relapse

Review in December 2018

Tumor marks: CEA: 17.89ng/ml; CA19-9: 31.68U/ml.

Abdominal pelvic enhancement CT: The lymphadenopathy of the abdominal aorta is enlarged, with a long diameter of 31mm.

PET-CT: The lymphadenopathy of the lymphadenopathy of the abdominal aorta, 2.4*3.1cm high metabolism, consider the transfer

ask

How to choose a follow -up treatment plan?

A. Surgical resection

B. Continue chemotherapy

(Please think first 1 minute before checking down)

Answer:

Due to the close relationship with the abdominal aorta, the long diameter is 31mm, and the auxiliary chemotherapy has been more than one year before the operation. The chemotherapy scheme is valid. Continue to give meniacum combined with chemotherapy: XELOX scheme.

Review in February 2019

Abdominal pelvic enhancement CT: The lymphadenopathy of the abdominal aphority arteries has shrunk compared to the front, long diameter 26mm

Clinical diagnosis: After the sigmical colon cancer, the metastasis metastasis of the abdominal aorta of the abdomen

ask

How to choose a follow -up treatment plan?

A. The combination of chemotherapy is effective, and continue chemotherapy

B. Creating surgery

(Please think first 1 minute before checking down)

Answer:

Due to the narrowing of the lesion, no other irregular distant metastasis can be selected according to the situation during the operation.

In the same month, laparoscopic complex bowel adhesion+peritoneal posterior lymph node cleansing

Seeing during the operation: 2.5*3.0cm tuber on the left side of the abdominal aorta, and the limits of the abdominal aorta and the left ureteral boundary

Postoperative pathological: medium -divide adenocarcinoma infiltration, no cancer is seen

Continue varicose vein combined with chemotherapy after surgery: XELOX solution

Labramid lymph node cleansing surgery

The tumor logo is scheduled regularly after surgery, and there is no obvious abnormal abnormality in the abdominal pelvic enhancement CT.

The recurrence rate of the recurrence of lymph node metastasis of the isolation peritoneum is 4%-10%, the metastasis of the metastasis metastasis metastasis of the isolation aorta mirality is 1.3%-1.7%. %.

In the past, the prognosis of patients had poor prognosis and did not perform saving surgery. In recent years, chemotherapy and radiotherapy technologies have made progress, and new chemotherapy plans have continued to develop. It can be used as a potential healing therapy for patients with an isolated peritoneal lymph node metastatic tumor.

What are the differences in European, American and Japanese guidelines? How do we treat my country?

European and American colorectal cancer treatment guidelines and scholars in the field of surgery do not recommend surgical treatment:

The metastasis metastasis of the peritoneal is metastasis, and the posterior lymph node metastasis is low, and the operation of surgery is high. The risk of bleeding and nerve damage during surgery is high. Freckage can replace surgery, improve the control of the bureau, and improve the survival rate.

Recommended surgical treatment in Japan's colorectal cancer treatment guidelines and surgery:

The metastasis metastasis of the peritoneal is regional lymph node metastasis. Surgical cleaning can increase the survival rate, and surgical resection can achieve cure.

The status quo in the field of surgical in China: less research, but there are also these two different views

Limited peritoneal lava lymphatic sisters are metastasized as non -broad metastasis. The local treatment of high -selection cases may improve prognosis. Federation or simplicity of chemotherapy may achieve a cure effect. New assisted chemotherapy before surgery may cause some patients to avoid surgery.

Insurance lymph node scanning surgery and contraindications

Indications: isolation, regional peritoneal hypogonal metastasis metastasis (below the left renal vein), recurrence of post -lymph node metastases of the peritoneal, no other non -removed distant metastasis, generally good and capable of tolerance.Contraindications: Wide peritoneal tunnel metastasis, accompanied by irregular distant metastasis, patients are generally poor and unbearable.

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The first release of this article: the medical world tumor channel