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Evaluation of lateral lymph node dissection with preoperative chemo-radiotherapy for the treatment of advanced middle to lower rectal cancers

  • K. KodaEmail author
  • N. Saito
  • K. Oda
  • N. Takiguchi
  • H. Sarashina
  • M. Miyazaki
Original Article

Abstract

Background and aims

This study examined rectal cancers with lateral lymph node (LN) metastases and whether lateral lymph node dissection (LLD) with or without preoperative chemo-radiotherapy (XRT) benefits patients with rectal cancer.

Patients and methods

A total of 452 consecutive cases of curatively resected pT2, pT3, and pT4 middle to lower rectal cancers were retrospectively analyzed. Of these, 265 patients underwent curative LLD and 155 XRT. Data were evaluated with respect to the cumulative percentage of survival.

Results

Lateral LN metastases were identified in 7.7% of patients. Of the pT3/pT4 extraperitoneal cancer patients 13.5/18.8% had lateral LN metastases. In the treatment of middle rectal cancers and pT2 extraperitoneal cancers LLD either with or without XRT did not improve survival rate. For the treatment of pT3/pT4 extraperitoneal tumors prior to the introduction of total mesorectal excision (TME) in 1994 LLD plus XRT yielded significantly better survival and local control than conventional surgery without LLD or XRT, although LLD alone did not improve either survival or local recurrence rates. Since 1995 TME with or without subsequent LLD has yielded favorable results for the treatment of extraperitoneal tumors.

Conclusion

For the treatment of middle rectal cancers and pT2 extraperitoneal cancers LLD either with or without XRT does not improve survival rate. For pT3/pT4 extraperitoneal tumors, which are associated with a high incidence of lateral node metastasis, combining treatment modalities such as TME followed by LLD or XRT followed by TME may be considered.

Keywords

Rectal cancer Lateral lymph node dissection Preoperative chemo-radiotherapy Total mesorectal excision 

References

  1. 1.
    Abulafi AM, Williams NS (1994) Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 81:7–19PubMedGoogle Scholar
  2. 2.
    Church JM, Raudikivi PJ, Mill BL (1987) The surgical anatomy of the rectum-a review with particular reference to the hazards of rectal mobilisation. Int J Colorectal Dis 2:158–166PubMedGoogle Scholar
  3. 3.
    Enker WE (1992) Potency, cure and local control in the operative treatment of rectal cancer. Arch Surg 127:1396–1401PubMedGoogle Scholar
  4. 4.
    Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16:848–857PubMedGoogle Scholar
  5. 5.
    Wiig JN, Carosen E, Soreide O (1998) Mesorectal excision for rectal cancer: view from Europe. Semin Surg Oncol 15:78–86CrossRefPubMedGoogle Scholar
  6. 6.
    Jones OM, Smeulders N, Wiseman O, Miller R (1999) Lateral ligaments of the rectum: an anatomical study. Br J Surg 86:487–489CrossRefPubMedGoogle Scholar
  7. 7.
    Nano M, Levi AC, Borghi F, Bellora P, Bogliatto F, Garbossa D, Bronda M, Lanfranco G, Moffa F, Dorfl J (1998) Observation on surgical anatomy for rectal cancer surgery. Hepatogastroenterology 45:717–726PubMedGoogle Scholar
  8. 8.
    Sato K, Sato T (1991) The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 13:17–22PubMedGoogle Scholar
  9. 9.
    Takeuchi O, Saito N, Koda K, Sarashina H, Nakajima N (1999) Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer. Br J Surg 86:932–937CrossRefPubMedGoogle Scholar
  10. 10.
    Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315PubMedGoogle Scholar
  11. 11.
    Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg 383:409–415PubMedGoogle Scholar
  12. 12.
    Saito N, Sarashina H, Nunomura M, Koda K, Takiguchi N, Nakajima N (1998) Clinical evaluation of nerve-sparing surgery combined with preoperative radiotherapy in advanced rectal cancer patients. Am J Surg 175:277–282CrossRefPubMedGoogle Scholar
  13. 13.
    Hojo K, Koyama Y (1982) The effectiveness of wide anatomical resection and radical lymphadenectomy for patients with rectal cancer. Jpn J Surg 12:111–116PubMedGoogle Scholar
  14. 14.
    Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, Kubo R, Kitaoka M, Nakamura M, Fujimoto K, Inufusa H, Hatta M, Izumoto G (1994) Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum 37:219–223PubMedGoogle Scholar
  15. 15.
    Hida J, Yasutomi M, Tokoro T, Kubo R (1999) Examination of nodal metastases by a clearing method supports pelvic plexus preservation in rectal cancer surgery. Dis Colon Rectum 42:510–514PubMedGoogle Scholar
  16. 16.
    Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354PubMedGoogle Scholar
  17. 17.
    Yasutomi M (1997) Advances in rectal cancer surgery in Japan. Dis Colon Rectum 40 [Suppl]:S74–S79Google Scholar
  18. 18.
    Bonadeo FA, Vaccaro CA, Benati ML, Quintana GM, Garione XE, Telenta MT (2001) Rectal cancer: local recurrence after surgery without radiotherapy. Dis Colon Rectum 44:3:374–379Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • K. Koda
    • 1
    Email author
  • N. Saito
    • 2
  • K. Oda
    • 1
  • N. Takiguchi
    • 1
  • H. Sarashina
    • 1
  • M. Miyazaki
    • 1
  1. 1.Department of General Surgery, Graduate School of MedicineChiba UniversityChiba CityJapan
  2. 2.Department of SurgeryNational Cancer Center East HospitalKashiwa CityJapan

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