Abstract
PURPOSE: The aim of this study was to evaluate the roles of the lymphadenectomy in the surgical treatment of rectal cancer. METHODS: On the basis of our experience of 252 curative operations for rectal cancer, we analyze survival and recurrences in relation to the lymph node involvement and to the level of the lymph nodes where the metastases are located. All patients underwent a lymphadenectomy with high ligation of the inferior mesenteric artery and removal of the lumboaortic lymph nodes from the left renal vein to the aortic bifurcation. Pelvic lymphadenectomy was performed in 16 cases. RESULTS: Five-year survival was 70.6 percent in patients with no lymph node involvement, 68.2 percent in patients with pararectal lymph nodes N+, 25 percent in patients with involvement of intermediate lymph nodes, and 30 percent in patients with involvement of lumboaortic lymph nodes. In no case was there involvement of the hypogastric lymph nodes. On the basis of our experience and from results in the literature, we consider an upward extended lymphadenectomy with high ligation of the inferior mesenteric artery is warranted since it enables the tumor to be staged accurately and may lead to survival even in cases of advanced lymph node involvement.
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References
Hojo K. Anastomotic recurrence after sphincter saving resection of rectal cancer. Dis Colon Rectum 1986;29:11–4.
Kirwan WO, O'Riordain MG, Waldron R. Declining indications for abdominoperineal resection. Br J Surg 1989;76:1061–3.
McDermott FT, Hughes ES, Pihl E,et al. Changing survival prospects in rectal carcinoma. A series of 1306 patients managed by one surgeon. Dis Colon Rectum 1986;29:798–803.
Leggeri A, Liguori G, de Manzini N, Balani A. La conservation sphincterienne dans la chirurgie du cancer du rectum. Chirurgie 1987;113:785–92.
Anderberg B, Enblad P, Sjodahl R, Wetterfors J. Recurrent rectal carcinoma after anterior resection and rectal stapling. Br J Surg 1984;71:98–100.
Mohiuddin M, Kramer S, Marks G, Dobelbower RR. Combined pre and post-operative radiation for carcinoma of the rectum. Int J Radiat Oncol Biol Phys 1982;8:133–6.
Enker WE, Pilipshen SJ, Heilweil ML,et al. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer. Ann Surg 1986;203:426–33.
Malafosse M, Fourtanier G, Rougier P, Bugat R, Baudot P, Gravie JF. Le traitement des cancer du rectum. Monografies de l'Association Francaise de Chirurgie. Paris: Masson Ed, 1987.
Pezim ME, Nicholls RJ. Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 1984;200:729–33.
Surtees P, Ritchie JK, Phillips RK. High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 1990;77:618–21.
Hojo K, Kojama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982;144:350–4.
Stearns MW Jr, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 1959;2:169–72.
Deddish MR. Surgical procedures for carcinoma of the left colon and rectum, with five-year end results following abdominopelvic dissection of lymph nodes. Am J Surg 1960;99:188–91.
Di Matteo G, Mascagni D, Tarroni D. Radical surgery for rectal cancer. J Surg Oncol 1991;2:32–5.
Di Matteo G, Mascagni D, Palazzini G, Berni A. Modalità di diffusione del cancro del retto e principi di radicalità chirurgica. Ann Ital Chir 1992;3:261–6.
Liguori G, Roseano M, Balani A, Turoldo A. La resezione anteriore bassa nel trattamento chirurgico curativo del cancro del retto. Ann Ital Chir 1992;3:271–7.
Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following curative surgery for large bowel cancer. I: the overall picture. The rectum and sigmoid. Br J Surg 1984;71:12–20.
Grinnell RS. Results of ligation of the inferior mesenteric artery at the aorta in resection of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet 1965;120:1031–6.
Dworak O. Morphology of lymph nodes in the resected rectum of patients with rectal carcinoma. Pathol Res Pract 1991;187:1020–4.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence. Br J Surg 1982;69:613–6.
Sauer I, Bacon HE. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Ann J Surg 1951;81:111–20.
Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 1989;32:307–15.
Glass RE, Ritchie JK, Thompson HR, Mann CV. The results of surgical treatment of cancer of the rectum by radical resection and extended abdominoiliac lymphadenectomy. Br J Surg 1985;72:599–601.
Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide iliopelvic lymphadectomy in patients with carcinoma of rectum, compared with conventional lymphadectomy. Dis Colon Rectum 1989;32:128–33.
Kato T, Hirai T, Yasui K, Nakazato H. Developments in the surgical treatment of rectal cancer in view of the quality of life. Gan To Kagaku Ryoho 1990;17:741–6.
Milson J, Graffner H. Intrarectal ultrasonography in rectal cancer staging and in the evaluation of pelvic disease. Ann Surg 1990;212:602–6.
Katzura Y, Kazutaka Y, Takashi I, Yoshinaka H, Hisaaki S. Endorectal ultrasonography for the assessment of the wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum 1992;35:362–8.
Beynon J, Mortensen NJ, Channerjl N, Rigby H, Virjie J. Preoperative assessment of mesorectal lymph node involvement in rectal cancer. Br J Surg 1989;76:276–9.
Cohen J, Grotz R, Welch J, Deckers P. Intrarectal sonography. A new technique for the assessment of rectal tumours. Am Surg 1991;57:459–62.
Glaser F, Schlag P, Herfath C. Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement. Br J Surg 1990;77:883–7.
Dargent D, Salvat J. Envahissement ganglionnaire pelvien. New York: Medsi/McGraw-Hill, 1989.
Tagliacozzo S. Ruolo della linfoadenectomia nel trattamento del cancro del retto. Ann Ital Chir 1992;3:267–70.
Machiki Y, Azekura K, Ohta H,et al. A clinical study of 76 cases in carcinoma of the colon and rectum with metastasis to the peri-aortic lymph nodes. With particular reference to the skip metastasis in carcinoma of the sigmoid colon to the peri-aortic lymph nodes. Nippon Geka Gakai Zasshi 1990;91:844–50.
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Leggeri, A., Roseano, M., Balani, A. et al. Lumboaortic and iliac lymphadenectomy: What is the role today?. Dis Colon Rectum 37 (Suppl 2), S54–S61 (1994). https://doi.org/10.1007/BF02048433
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DOI: https://doi.org/10.1007/BF02048433