Advantages and Disadvantages of Extended Pelvic Lymphadenectomy for Lower Rectal Cancer

Tomoyuki Kato, Takashi Hirai, Yasuhiro Kodera, Akihito Torii, Katsuhiko Uesaka, Kenzo Yasui, Takeshi Morimoto, Yoshitaka Yamamura, Tsuyoshi Kito

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital

Two hundred and seventy-two patients with advanced lower rectal cancer who received curative resection from 1975 to 1991 were reviewed. Five-year survival rates were 61.5% in the patients without pelvic lymphadenectomy (No PLA) and 79.5% in the patients with intra-abdominal combined with extra-peritoneal pelvic lymphadenectomy (Abd + Extra). The difference between the two groups was significant. The pelvic recurrence rate in the No-PLA gruop was 20.6% , whereas it was 5.4% in the Abd + Extra group, also a significant difference. It seemed that inadequate pelvic lymphadenectomy such as blunt dissection causes the prognosis to be worse than No PLA. Although extended pelvic lymphadenectomy decreased the incidence of pelvic local recurrence and prolonged postoperative survival, there were increased incidences of urine-voiding dysfunction. Urine-voiding dysfunction appeared in 80% of Abd + Extra but only 11%o of No PLA. Autonomic nerve-preserving surgery was performed from 1987 in order to decrease urinary and sexual dysfunction. The five-year disease-free survival rate of the nerve preserving operation was 81.8%, and there was no local recurrence. The voiding dysfunction rate was 12.5% in patients with complete nerve preservation, almost the same as in No PLA. Erectile dysfunction was seen in 26.7% and ejaculatory dysfunction in 66.7% of male patients.

Key words
extended pelvic lymphadenectomy for advanced cancer of the lower rectum, nerve preserving operation for cancer of the rectum, autonomic nerve dysfunction afte operation for cancer of the rectum

Reprint requests
Tomoyuki Kato Department of Gastroenterological Sugery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusa-ku, Nagoya, 464 JAPAN

Accepted
December 7, 1994

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