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World Journal of Surgery

, Volume 21, Issue 7, pp 728–732 | Cite as

Importance of Extended Lymphadenectomy with Lateral Node Dissection for Advanced Lower Rectal Cancer

  • Yoshihiro Moriya
  • Kenichi Sugihara
  • Takayuki Akasu
  • Shin Fujita

Abstract. A total of 448 patients with advanced lower rectal cancer who underwent curative wide lymphadenectomy with autonomic nerve preservation were reviewed with respect to surgical techniques, operative burdens, node status, survival rate, and mode of recurrence. Operative time and blood loss in patients who underwent lateral dissection were much greater than those encountered with conventional resection. According to the direction of lymphatic spread in patients with Dukes C disease, the incidence of upward spread was 94% and lateral spread 27%. The overall incidence of lateral metastasis was 14%. The overall 5-year survival was 70%. According to the Dukes classification, the 5-year survival rates were 92% for Dukes A, 79% for Dukes B, and 55% for Dukes C, whereas it was 43% in patients with lateral node metastasis. An analysis of the survival rate was carried out with regard to the number of node metastases, direction of lymphatic spread, and autonomic nerve preservation. The overall incidence of local recurrence was 9.3% and amounted to 16.0% in patients with Dukes C disease. The case of advanced lower rectal cancer was characterized by positive lymph nodes or circular lesions around the circumference (both diagnosed by endorectal ultrasonography). We recommend extended lymphadenectomy with lateral node dissection, as it preserves the autonomic nerve.

Keywords

Node Metastasis Positive Lymph Node Autonomic Nerve Lateral Spread Lateral Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirugie 1997

Authors and Affiliations

  • Yoshihiro Moriya
    • 1
  • Kenichi Sugihara
    • 1
  • Takayuki Akasu
    • 1
  • Shin Fujita
    • 1
  1. 1.Department of Surgery, National Cancer Center, 1-1 Tsukiji 5-chome, Chuo-ku, Tokyo 104, JapanJP

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