A Role of Radical Abdominopelvic Lymphadenectomy in the Surgical Management of Lower Rectal Cancer

Kazutaka Yamada, Kiyoshi Niwa, Shigeya Hase, Takashi Sameshima, Kouichi Arimura, Yutaka Tyuman, Fujirou Kinoshita, Yuji Takebayashi, Kanehiro Matsushita, Takashi Ishizawa, Takashi Aikou

First Department of Surgery, Kagoshima University School of Medicine

We reviewed our experience with lymphadenectomy for lower rectal cancer during the past 17 years, dividing patients into 144 treated by radical abdominopelvic lymphadenectomy (RAPL group) and 108 who underwent conventional lymphadenectomy (CONV group). Compared with CONV, RAPL was adopted in younger patients or patients with more advanced cancer, but the operative mortality rates of the two groups were not different. Although the 10-year survival rate did not differ between the RAPL and CONV groups in patients with Dukes A or Dukes B tumors, the survival rate of the RAPL group showed some improvement in patients with Dukes C tumor. In the CONV group, the survival rate of patients who had Dukes C tumor with lymphatic invasion was significantly lower than that of patients without lymphatic invasion. Similar results were found for venous invasion. However, the survival of patients who underwent RAPL was not influenced by the presence of lymphatic or venous invasion. On the other hand, the incidence rates of metastasis of inferior mesenteric and iliopelvic lymph nodes in patients who underwent RAPL were 14.5% and 15.3%. Five-year survival in patients with only inferior mesenteric metastasis was 68.2%, that with only iliopelvic metastasis was 43.0%, while that with both inferior mesenteric and iliopelvic metastases was 0%. These results suggested that RAPL was worth adopting in patients with lower rectal cancer of Dukes C, although the efficacy of RAPL for improvement of outcome in patients with metastasis of both inferior and iliopelvic lymph nodes was limited.

Key words
lymphnode metastasis of the lower rectal cancer, radical abdominopelvic lymphadenectomy

Reprint requests
Kazutaka Yamada First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
April 5, 1995

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