Abstract
This study was undertaken to determine if the degree of lymphadenectomy correlates with the prevention of local recurrence. The authors retrospectively reviewed the clinical data of 269 patients who underwent curative surgery for rectal cancer. The study was divided into three periods based on the method of lymphadenectomy as follows: period I (1963–1979) when extended lymphadenectomy was not performed; period II (1980–1985) when this was partially done with no attempt to dissect the obturator and proximal middle rectal lymph nodes; and period III (1986–1990) when this was completely performed for patients with appropriate indications. The local recurrence rates were 21%, 10%, and 8% for Periods I, II, and III, respectively (P<0.05). The incidence of local recurrence tended to be greater in period I versus periods II and III according to type of operation, location, and stage of the primary tumors. The local recurrence rates arising from lateral node metastases were 11%, 4%, and 2% for periods I, II, and III, respectively (P<0.05), while the incidence related to an insufficient surgical margin was approximately 5% throughout the three periods. We thus conclude that the degree of lymphadenectomy is a major determinant of local recurrence following a curative operation for rectal cancer.
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References
Morson BC, Vaughan EG, Bussey HJR (1963) Pelvic recurrence after excision of rectum for carcinoma. Br Med J 2:13–18
Secco GB, Fardelli R, Campora E, Rovida S, Bertoglio S (1989) Factors influencing local recurrence after curative surgery for rectal cancer. Oncology 46:10–13
Phillips RKS, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following “curative” surgery for large bowel cancer: I. The overall picture. Br J Surg 71:12–16
Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision. Lancet i:996–999
Michelassi F, Block GE, Vannucci L, Montag A, Chappell R (1988) A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma. Ann Surg 208:379–389
Welch JP, Donaldson GA (1978) Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 135:505–511
Williams NS (1984) The rationale for preservation of the anal sphincter in patients with low rectal cancer. Br J Surg 71:575–581
Enker WE, Heilweil ML, Hertz REL, Pilipshen SJ, Stearns MW, Sternberg SS, Janov AJ (1986) En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer. Ann Surg 203:426–433
Gunderson LL, Sosin H (1974) Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Cancer 34:1278–1292
Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
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 32:307–315
Glass RE, Ritchie JK, Thompson HR, Mann CV (1985) The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy. Br J Surg 72:599–601
Heimann TM, Szporn A, Bolnick K, Aufses AH (1986) Local recurrence following surgical treatment of rectal cancer: Comparison of anterior and abdominoperineal resection. Dis Colon Rectum 29:862–864
Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–851
Påhlman L, Glimelius B (1984) Local recurrences after surgical treatment for rectal carcinoma. Acta Chir Scand 150:331–335
Malcolm AW, Perencevich NP, Olson RM, Hanley JA, Chaffey JT, Wilson RE (1981) Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum. Surg Gynecol Obstet 152:131–136
Schiessel R, Wunderlich M, Herbst F (1986) Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 73:342–344
Welch JP, Donaldson GA (1979) The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 189:496–502
Berge T, Ekelund G, Mellner C, Pihl B, Wenekert A (1973) Carcinoma of the colon and rectum in a defined population. Acta Chir Scand 438[Suppl]:1–84
Olson RM, Perencevich NP, Malcolm AW, Chaffey JT, Wilson RE (1980) Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 45:2969–2974
Benotti PN, Bothe A, Eyre RC, Cady B, McDermott WV, Steele G (1987) Management of recurrent pelvic tumors. Arch Surg 122:457–460
Carlsson U, Lasson A, Ekelund G (1987) Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 30:431–434
Feil W, Wunderlich M, Kovats E, Neuhold N, Schemper M, Wenzl E, Schiessel R (1988) Rectal cancer: factors influencing the development of local recurrence after radical anterior resection. Int J Colorect Dis 3:195–200
Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G (1983) Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 52:1317–1329
Törnquist A, Ekelund G, Leandoer L (1982) The value of intensive follow-up after curative resection for colorectal carcinoma. Br J Surg 69:725–728
Pheils MT, Chapuis PH, Newland RC, Colquhoun K (1983) Local recurrence following curative resection for carcinoma of the rectum. Dis Colon Rectum 26:98–102
Pilipshen SJ, Heilweil M, Quan SHQ, Sternberg SS, Enker WE (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362
Moossa AR, Ree PC, Marks JE, Levin B, Platz CE, Skinner DB (1975) Factors influencing local recurrence after abdomino-perineal resection for cancer of the rectum and rectosigmoid. Br J Surg 62:727–730
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Suzuki, K., Muto, T. & Sawada, T. Prevention of local recurrence by extended lymphadenectomy for rectal cancer. Surg Today 25, 795–801 (1995). https://doi.org/10.1007/BF00311455
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DOI: https://doi.org/10.1007/BF00311455