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Lateral pelvic lymph node dissection for stage II/III rectal cancer: Is it really enough?
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M. Ota1,
A. Ishibe2,
I. Endo2 |
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1Gastroenterological Center, Yokohama City University Medical Center, 2Gastroenterological Surgery, Yokohama City University |
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| Purpose: Lateral pelvic node metastases occur in 10 to 20 % of stage II/III lower rectal cancer. Japanese standard treatment for stage II/III lower rectal cancer is surgery alone with lateral pelvic lymph node dissection(LPLND) ; this strategy differs from other countries. We assessed the oncological outcomes of LPLND and discussed its limitation for local control.Methods: Four hundred and thirty-two patients of cStage II/III rectal cancer who underwent LPLN were retrospectively assessed in terms of overall survival(OS), relapse free survival(RFS) and local recurrence rate(LRR). Risk factor of local recurrence was also evaluated by multivariate analysis.Results: LPLN metastases occurred in 45 cases (10.6%) in this series. 5y-OS was 83.8% among these 432 patients. 5y-RFS was 78.8% in patients without LPLN metastasis, 44.2% in patients with LPLN metastasis. LRR was 6.4% in total. Significant risk factors of local recurrence were tumor distance from anal verge (10.4% for tumors within 3cm), tumor type (20.8% for type 3), and depth of tumor (9.0% for T3/4). Conclusion: Lateral pelvic lymph node dissection doesn't have enough local control effect in cases with lower location and locally advanced tumor. Additional therapy, such as preoperative chemoradiation therapy, should be taken into consideration in these cases. |
Index Term 1: lateral pelvic lymph node dissection
Index Term 2: rectal cancer |
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