Rational Lateral Dissection for Cura A Lower Rectal Cancer

Hidejirou Kawahara, Katsuya Hirai, Teruaki Aoki, Ken Ashikaga, Keiichi Sato, Masashi Ono, Toshimasa Suzuki

Department of Surgery, Jikei University School of Medicine

In the 14 years from 1980 to 1993, we experienced 171 patients with cura A lower advanced rectal cancer who had received D2 or D3 lateral dissection. Those patients were examined regarding rational lateral dissection for lower rectal advanced cancer. Stage II, IIIa and stage IIIb without lymph node metastasis to the 2nd lymph node group or more, accounted for about 90% of all cases, there was no significant difference in the accumulated survival rates between the D2 and D3 dissection groups. On the other hand, in the D3 dissection group with lateral lymph node metastasis to the 2nd lymph node group or more, the other 10% of all patients, half of them had nong-term survival, over 5 years. Therefore we should carry out lateral dissection along the surface of the internal iliac artery, so-called D2 dissection, for lower advanced rectal cancer, and D3 dissection should be carried out in the patients who were judged as positive for metastasis in the lateral 2nd or 3rd lymph node group for pathological assessment during surgery. As for the patients with extra capsular lesions, the lesions are not curable by surgery alone.

Key words
lateral dissection for lower rectal cancer, extra capsular lesion, prognosis of lower rectal cancer, lymph node metastasis of lower rectal cancer, local recurrence of lower rectal cancer

Reprint requests
Hidejirou Kawahara Department of Surgery, Jieki University School of Medicine
3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
September 16, 1998

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