IMPORTANCE OF EXTENDED LYMPHADENECTOMY WITH LATERAL NODE DISSECTION FOR ADVANCED LOWER RECTAL-CANCER

A total of 448 patients with advanced lower rectal cancer who underwen t curative wide lymphadenectomy with autonomic nerve preservation were reviewed with respect to surgical techniques, operative burdens, node status, survival rate, and mode of recurrence. Operative time and blo od loss in patients who underwent lateral dissection were much greater than those encountered with conventional resection. According to the direction of lymphatic spread in patients with Dukes C disease, the in cidence of upward spread was 94% and lateral spread 27%. The overall i ncidence of Lateral metastasis was 14%. The overall 5-year survival wa s 70%. According to the Dukes classification, the 5-year survival rate s were 92% for Dukes A, 79% for Dukes B, and 55% for Dukes C, whereas it was 43% in patients with lateral node metastasis. An analysis of th e survival rate was carried out with regard to the number of node meta stases, direction of lymphatic spread, and autonomic nerve preservatio n, The overall incidence of local recurrence was 9.3% and amounted to 16.0% in patients with Dukes C disease. The case of advanced Lower rec tal cancer was characterized by positive lymph nodes or circular lesio ns around the circumference (both diagnosed by endorectal ultrasonogra phy). We recommend extended lymphadenectomy with lateral node dissecti on, as it preserves the autonomic nerve.