Lateral Lymph Node Dissection in Treatment for Advanced Lower Rectal Cancer

Yuji Nakafusa, Yoshimi Hirohashi, Toshiya Tanaka, Yoshihiko Kitajima, Seiji Sato, and Koji Miyazaki

Department of Surgery, Saga Medical School

Lateral lymph node dissection (LLD) is widely accepted for treating advanced lower rectal cancer in Japan. To clarify the effectiveness of LLD, we retrospectively analyzed the relationship of clinicopathological features to lateral lymph node metastasis and postoperative prognosis with or without LLD in 76 patients with advanced lower rectal cancer. Significantly improved survival was associated with decreased local recurrence in tumors of pT3-4 (5-year 86. 1% vs 58.5%, p<0.05), 3 cm or more in maximum diameter (5-year 86. 7% vs 64. 9%, p<0.05), and well or moderately differentiated adenocarcinoma (5-year 88.1% vs 69.8%, p<0.05) with LLD. Frequency of lateral lymph node metastasis increased in patients with positive upward lymph node metastasis (5/16 cases vs 0/18 cases, p<0.05) while LLD did not affect their survival and prognosis of patients in Dukes C was poor. Thus, it is recommended to apply LLD to advanced lower rectal cancer patients with tumors of pT3-4, 3 cm or more in maximum diameter, well or moderately differentiated adenocarcinoma, and positive upward lymph node metastasis. However, prognosis of patients in Dukes C, even received operation with LLD, is still poor.

Key words
lateral lymph node dissection, rectal cancer, treatment for rectal cancer, lymph node metastasis of rectal cancer, prognosis of rectal cancer

Reprint requests
Yuji Nakafusa Department of Surgery, Saga Medical School 5-1-1 Nabeshima, Saga, 849-8501 JAPAN

Accepted
June 26, 2001

To read the PDF file you will need Abobe Reader installed on your computer.