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Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer

  • Original Contributions
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Diseases of the Colon & Rectum

Purpose

This study was designed to clarify indication and benefit of pelvic sidewall dissection for rectal cancer.

Methods

The retrospective, multicenter study collected the data of rectal cancer patients who underwent surgery between 1991 and 1998 and were prospectively followed.

Results

Of 1,977 patients with rectal cancers, 930 underwent pelvic sidewall dissection without adjuvant radiotherapy. Positive lateral lymph nodes were found in 129. Multivariate analysis disclosed a significantly increased incidence of positive lateral lymph nodes in female gender, lower rectal cancers, non-well-differentiated adenocarcinoma, tumor size of ≥4 cm and T3-T4. The five-year survival rate for 1,977 patients was 79.7 percent. The survival of patients with positive lateral lymph nodes was significantly worse than that of Stage III patients with negative lateral lymph nodes (45.8 vs. 71.2 percent, P<0.0001). Multivariate analysis showed significantly worse prognosis in male gender, pelvic sidewall dissection, lower rectal cancers, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes. During the median follow-up time of 57 months, recurrence developed in 19.7 percent: 17 percent in negative and 58.1 percent in positive lateral lymph nodes (P<0.0001). Local recurrence was found in 8 percent: 6.8 percent in negative and 25.6 percent in positive lateral lymph nodes (P<0.0001). Multivariate analysis disclosed that lower rectal cancers, non-well-differentiated adenocarcinoma, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes were significantly associated with an increased local recurrence.

Conclusions

Positive lateral lymph node was the strongest predictor in both survival and local recurrence. Pelvic sidewall dissection may be indicated for patients with T3-T4 lower rectal cancers because of the greater provability of positive lateral lymph nodes.

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Acknowledgments

Participating investigators served as scientific investigator and collecting data: Masamichi Yasuno, M.D., Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School; Yukio Saito, M.D., Department of Surgery, International Medical Center of Japan; Masato Ono, M.D., Department of Surgery, National Cancer Center East; Jin-ichi Hida, M.D.4, First Department of Surgery, Kinki University, School of Medicine; Takayuki Morita, M.D., Second Department of Surgery, Hirosaki University, School of Medicine; Masahiko Watanabe, M.D., Department of Surgery, Keio University, School of Medicine; Masashi Ueno, M.D., Department of Surgery, Cancer Institute Hospital.

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Authors and Affiliations

  1. Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kenichi Sugihara M.D. & Hirotoshi Kobayashi M.D.

  2. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Tomoyuki Kato M.D.

  3. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Takeo Mori M.D.

  4. Department of Surgery, National Defense Medical College, Saitama, Japan

    Hidetaka Mochizuki M.D.

  5. Second Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Shingo Kameoka M.D.

  6. Department of Surgery, Kurume University, School of Medicine, Fukuoka, Japan

    Kazuo Shirouzu M.D.

  7. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan

    Tetsuichiro Muto M.D.

Authors
  1. Kenichi Sugihara M.D.
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  2. Hirotoshi Kobayashi M.D.
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  3. Tomoyuki Kato M.D.
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  4. Takeo Mori M.D.
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  5. Hidetaka Mochizuki M.D.
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  6. Shingo Kameoka M.D.
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  7. Kazuo Shirouzu M.D.
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  8. Tetsuichiro Muto M.D.
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Corresponding author

Correspondence to Kenichi Sugihara M.D..

Additional information

Study Group for Rectal Cancer Surgery of the Japanese Society for Cancer of the Colon and Rectum.

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Sugihara, K., Kobayashi, H., Kato, T. et al. Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer. Dis Colon Rectum 49, 1663–1672 (2006). https://doi.org/10.1007/s10350-006-0714-z

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