Advantages and Disadvantages of Extended Surgery for Lower Rectal Cancer

Yoshihiro Moriya, Kennichi Sugihara, Takayuki Akasu, Shin Fujita

Department of Surgery, National Cancer Center Hospital

A total of 403 patients with invasive lower rectal cancer received curative resection with lateral dissection and were classifiled into two groups, an "extended" group [270] who received so-called extended surgery and a "nerye-sparing" group [133] who received nerve-sparing surgery with lateral dissection. In the extended group, more than half of the patients were not satisfied with long-term urinary function. On the other hand, more than eighty percent of patients who received bilateral pelvic nerve preservation had acceptable urinary function. In terms of Dukes' C tumors, the disease-free 5-year survival rates were 46% for patients in the extended group and 59%o for patients in the nerve-sparing group. On the basis of the number of lymph nodes involved, the survival rate was significantly decreased in patients with more than four positive nodes compared to those with up to three positive nodes. Intrapelvic local recurrence rates were l4% in the extended group, and l3% in the nervesparing group. Our current policy calls for agressive application of extended surgery with partial preservation of autonomic nerves for patients with advanced lower rectal cancer.

Key words
lower rectal cancer, lateral node metastasis, Nerve-sparing operation for rectal cancer

Reprint requests
Moriya Yoshihiro Department of Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuoku, Tokyo, 104 JAPAN

Accepted
December 7, 1994

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