Results of Extended Lymph Node Dissection for Rectal Cancer

Takayuki Morita, Fumihiko Nakamura, takashi Itoh, Jun Suzuki, Kenichi Hakamada, Kazuhiro Matsuura, Takakazu Sugo, Mitsuru Konn

Department of Surgery, Hirosaki University School of Medicine

The significance of extended lymph node dissection was studied from the viewpoint of curability of rectal cancer and quality of life after surgery. Carcinoma metastasized mainly along the inferior mesenteric artery (IMA) to its base, while lateral lymphb node involvement occurred in cases with many metastatic lesions toward the IMA. The 5-year survival rate of lower rectal cancer was 36%, with a high incidence of lateral lymph node metastasis nad local recurrence. We introduced extended lymph node dissection in 1984, which included radical en block excision of the adipose tissue around the aorta and lateral lymph node dissection from the extraperitoneal approach. Abetter 5-year survival rate was attained with this procedure (1984-1990) than previously (967-1983) in n0 and nl groups, but no improvement was seen in the n2 grop. Postoperative urinary and sexual disturbances were recognized in most patients without bilateral pelvic nerve preservation, and deteriorating quality of life was observed after surgery. For improved better curability and fewer sequelae, extended lymph node dissection should be balanced with unilateral pelvic nerve preservation in surgery for rectal cancer.

Key words
lymph node metastasis of rectal cancer, extraperitoneal lymph node dissection, nerve preserving operation for rectal cancer

Reprint requests
Takayuki Morita Department of Surgery, Hirosaki University School of Medicine
5-Zaifuchou, Hirosakishi, 036 JAPAN

Accepted
December 7, 1994

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