LYMPH-NODE DISSECTION, STAGE MIGRATION AN D PERIOPERATIVE RISK OF RECTAL-CARCINOMA

In 348 patients with an initial diagnosis of rectal carcinoma operated on between 1985 and 1994 we investigated the quality of lymph node di ssection, its influence on the perioperative risk and tumor staging. T he same histopathological work-up was carried out in all cases. Whethe r resections or extirpations were performed, the number of dissected l ymph nodes increased from 5.3 and (1985/1986) to 16.7 and 17.3 (1991/1 992) and to 15.8 and 17.3 (1993/1994) respectively. Neither the type o f operation nor the surgeon's experience had a significant influence o n the number of lymph nodes dissected. The increase in the number of l ymph nodes dissected had no negative effect on the length of the opera tion, the amount of blood infused during the operation or the perioper ative risk. We found a significant correlation between the number of l ymph nodes dissected and the number of lymph node metastases (P = 0.02 ) and between an increase in UICC stage III (P = 0.005) and pN2 tumors (P = 0.000) and an increase in the number of lymph nodes dissected. C entral lymph node dissection by high ligation of the inferior mesenter ic artery did not increase the perioperative risk in spite of the fact that in recent years we have observed more patients with multiple dis eases.