Relationship between Lateral Dissection and Prognosis in Lower Rectal Cancer

Hidejirou Kawahara, Katsuya Hirai, Teruaki Aoki, Ken Ashikaga, Chiko Kimura, Keiichi Sato, Osmamu Kashiwazaki

Second Department of Surgery, Jikei University School of Medicine

Wedetermined the significance of the lateral dissection in lower rectal cancer cases, by comparing the D3 dissection group and the incomplete D2 dissection group. Incomplete D2 dissection is lymph node dissection along the frontal wall of the internal iliac artery, So in the group lymph nodes around the internal iliac artery was dissected only partially. Sixty-five patients with stage II-IIIb lower rectal cancer who had undergone D3 or incomplete D2 dissection between 1980 and 1991, without postoperative distant metastasis, were evaluated. In the stage II cases there was no significant difference in the cumulative survival rates between the D3 and incomplete D2 dissection groups. Therefore, it is enough for curability that the stage II patients undergo incomplete D2 dissection. On the other hand, in the stage IIIa, b patients, the D3 dissection group had a better 5-year survival rate than the incomplete D2 dissection group. The extension of group 2 lymph node metastasis was significantly greater in the D3 dissection group than the incomplete D2 dissection group. Therefore, the reason why the D3 dissection group has a better outcome than the incomplete D2 dissection group with lymph node metastasis is not only that the group 3 lymph nodes are dissected, but also that the extension of the group 2 lymph nodes, especially the lymph nodes at the internal iliac artery area, is dissected completely.

Key words
lower rectal cancer, lateral dissection, local recurrence of rectal cancer, perineural invasion of rectal cancer

Reprint requests
Hidejirou Kawahara Second Department of Surgery, The Jikei University School of Medicine
3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105 JAPAN

Accepted
October 11, 1995

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