J Korean Surg Soc.  2001 Aug;61(2):178-182.

Effect on the Local Recurrence and the Survival of Lateral Pelvic Node Dissection in Advanced Lower Rectal Cancer

• Han C
• Kim HR
• Kim DY
• Kim YJ

Abstract

PURPOSE: Colorectal cancer is the fourth leading cause of death among cancer patients in Korea. Over the last three decades, the overall survival rate of patients with rectal cancer has remained unchanged in Western countries, although somewhat improved in adjuvant trials. Meanwhile, although the use of extended lymphadenectomy, widely applied in Japan from the middle 1970s to the early 1980s, has significantly improved the survival rate following surgical treatment for advanced low rectal cancer, this kind of wide resection has resulted in a high incidence of urinary and sexual dysfunction. Therefore, lateral pelvic node dissection is still controversial. The use of lateral pelvic node dissection is currently a highly debated topic. The purpose of this study was to assess the significance of lateral pelvic node dissection in pelvic node metastasis.
METHODS
The study group was comprised of 524 rectal cancer patient who had undergone operation between 1985 and 1999 at the Department of Surgery, Chonnam National University Hospital, Of these patient, 26 presented with metastasis to the pelvic lymph node, 23 with metastasis to the inferior mesenteric lymph node, and 8 with metastasis to the paraaortic lymph node. Lymphadenectomy was not performed in 24 cases due to distant metastasis. Of the remainder, 133 cases exhibited pararectal lymph node metastasis around the primary tumor and 310 cases displayed no lymph node metastasis.
RESULTS
1) The age and sex distribution of patients with rectal cancer was similar in all the groups. 2) In 96.2% ofpatient in the pelvic node positive group, the primary presenting tumor was localized in the lower rectum. 3) There was no statistically significant difference between the pelvic node group and the other groups in term of local recurrence. The patients of the pelvic node positive group had a higher survival rate than both the IMA node positive group and the paraaortic node positive group (p<0.05).
CONCLUSION
Lateral pelvic node dissection may indeed provide significant benefits contributing toward an increased survival rate in rectal cancer patients.

Keyword

Rectal cancer; Lateral pelvic node

MeSH Terms

Cause of Death
Colorectal Neoplasms
Humans
Incidence
Japan
Jeollanam-do
Korea
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Rectal Neoplasms*
Rectum
Recurrence*
Sex Distribution
Survival Rate