DOES LATERAL LYMPH-NODE DISSECTION IMPROVE SURVIVAL IN RECTAL-CARCINOMA - EXAMINATION OF NODE METASTASES BY THE CLEARING METHOD

BACKGROUND: The treatment of rectal carcinoma by lateral lymph node di ssection has risks and benefits, Therefore, we investigated the therap eutic efficacy of lateral lymph node dissection. STUDY DESIGN: We stud ied 198 patients with rectal carcinoma who underwent lateral lymph nod e dissection. Metastases to the lymph nodes were examined by the clear ing method. The incidence of urinary and male sexual dysfunction was d etermined by measuring the residual urine volume and individual interv iew 1 year after operation. RESULTS: The rate of metastasis to lateral lymph nodes was 11.1 percent, and metastasis to the lateral lymph nod es occurred more frequently with lower rectal carcinoma classified as pT3 or pT4 in the TNM system. The rate of local recurrence was 12.5 pe rcent and the B-year survival rate after curative resection was 70.1 p ercent. The 5-year survival rate in patients with metastasis to the la teral lymph nodes was 25.1 percent, and this rate was significantly lo wer than the 5-year survival rate of 74.3 percent in patients without metastasis to the lateral lymph nodes. Urinary dysfunction was observe d in 67.5 percent of patients, and male sexual dysfunction was found i n 97.4 percent of men younger than 60 years of age with prior sexual a bility. CONCLUSIONS: The prognosis for patients with metastasis to the lateral lymph nodes is poor, and the improvement in survival rate fro m lateral lymph node dissection is minimal.