Skip to main content

Advertisement

SpringerLink
Log in

Prognostic significance of lateral lymph node dissection in node positive low rectal carcinoma

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study was performed to identify patients who would benefit from lateral lymph node (LLN) dissection for advanced low rectal carcinoma.

Methods

Clinical outcomes were retrospectively studied in 149 patients with node positive low rectal carcinoma undergoing LLN dissection according to LLN status: patients with (group II) or without positive LLNs (group I), and the number (≤3, >3), side (unilateral, bilateral), and site of positive LLNs.

Results

The overall 5-year survival rate was significantly worse in group II (36.2%) than that in group I (69.8%). The 5-year survival rate was significantly worse in patients with >3 positive LLNs, bilateral positive LLNs, and positive LLNs in both areas B and C (high-risk group) than that in patients with ≤3 positive LLNs, unilateral positive LLNs, and positive LLNs in either area B or C. The 5-year survival rate was significantly better in patients without any high-risk factors (54.2%, low-risk group II) than that in patients who belonged to the high-risk group (12.3%). There was no significant difference in 5-year survival rate between group I and low-risk group II. There were significantly more well and moderately differentiated adenocarcinoma, tumors with less than minimal lymphatic invasion, and tumors with less than six involved LNs in the mesorectum in low-risk group II than in high-risk group II.

Conclusions

LLN dissection for low rectal carcinoma was effective for patients with fewer than four positive unilateral LLNs in either area B or C.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  PubMed  CAS  Google Scholar 

  2. Enker W, Thaler H, Cranor M, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346

    PubMed  CAS  Google Scholar 

  3. Aitken R (1996) Mesorectal excision for rectal cancer. Br J Surg 83:214–216

    Article  PubMed  CAS  Google Scholar 

  4. Arbman G, Nilsson E, Hallbook O, Sjodahl R (1996) Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 83:375–379

    Article  PubMed  CAS  Google Scholar 

  5. Miles W (1931) The pathology of the spread of cancer of the rectum, and its bearing upon the surgery of the cancerous rectum. Surg Gynecol Obstet 52:350–359

    Google Scholar 

  6. Gilchrist R, David V (1938) Lymphatic spread of carcinoma of the rectum. Ann Surg 108:621–642

    Article  PubMed  CAS  Google Scholar 

  7. Coller F, Kay E, MacIntyre R (1940) Regional lymphatic metastasis of carcinoma of the rectum. Surgery 8:294–311

    Google Scholar 

  8. Grinnell R (1942) The lymphatic and venous spread of carcinoma of the rectum. Ann Surg 116:200–216

    Article  PubMed  CAS  Google Scholar 

  9. Bell S, Sasaki J, Sinclair G, Chapuis PH, Bokey EL (2009) Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues. Colorectal Dis 11:443–449

    Article  PubMed  CAS  Google Scholar 

  10. Sauer I, Bacon H (1951) Influence of lateral spread of cancer of the rectum on radicality of operation and prognosis. Am J Surg 81:111–120

    Article  PubMed  CAS  Google Scholar 

  11. Deddish M (1951) Abdominopelvic lymph-node dissection in cancer of the rectum and distal colon. Cancer 4:1364–1366

    Article  PubMed  CAS  Google Scholar 

  12. State D (1951) Combined abdominoperineal excision of the rectum: a plan for standardization of the proximal extent of dissection. Surgery 30:349–354

    PubMed  CAS  Google Scholar 

  13. Moreira L, Hizuta A, Iwagaki H, Tanaka N, Orita K (1994) Lateral lymph node dissection for rectal carcinoma below the peritoneal reflection. Br J Surg 81:293–296

    Article  PubMed  CAS  Google Scholar 

  14. Hida J, Yasutomi M, Fujimoto K, Maruyama T, Okuno K, Shindo K (1997) Dose lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg 184:475–480

    PubMed  CAS  Google Scholar 

  15. Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32:128–133

    Article  PubMed  CAS  Google Scholar 

  16. Maeda K, Maruta M, Utsumi T, Sato H, Toyama K, Matsuoka H (2003) Bladder and male sexual functions after autonomic nerve-sparing TME with or without lateral node dissection for rectal cancer. Tech Coloproctol 7:29–33

    Article  PubMed  CAS  Google Scholar 

  17. Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM, van de Velde CJ (1998) Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 85:92–97

    Article  PubMed  CAS  Google Scholar 

  18. Koyama Y, Moriya Y, Hojo K (1984) Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum: significant improvement of survival rate and decrease of local recurrence. Jpn J Clin Oncol 14:623–632

    PubMed  CAS  Google Scholar 

  19. Stearns MW Jr, Deddish MR (1959) Five year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 2:169–172

    Article  PubMed  Google Scholar 

  20. Sato H, Maeda K, Maruta M, Masumori K, Koide Y (2006) Who can get the beneficial effect from lateral lymph node dissection for Dukes C rectal carcinoma below the peritoneal reflection? Dis Colon Rectum 49(Supple):S3–S12

    Article  PubMed  CAS  Google Scholar 

  21. Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880

    Article  PubMed  CAS  Google Scholar 

  22. Japanese society for cancer of the colon and rectum (1997) Japanese classification of colorectal carcinoma, 1st English edn. Kanehara & Co., Tokyo

    Google Scholar 

  23. Heald RJ (1988) The “Holy Plane” of rectal surgery. T R Soc Med 81:503–508

    CAS  Google Scholar 

  24. MacFarlene JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    Article  Google Scholar 

  25. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711

    Article  PubMed  CAS  Google Scholar 

  26. Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    Article  PubMed  CAS  Google Scholar 

  27. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  PubMed  CAS  Google Scholar 

  28. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223

    Article  PubMed  CAS  Google Scholar 

  29. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  30. Takahashi T, Ueno M, Azekura K, Ohta H (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43(Suppl):S59–S68

    Article  PubMed  CAS  Google Scholar 

  31. Moriya Y, Sugihara K, Akasu T, Fujita S (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21:728–732

    Article  PubMed  CAS  Google Scholar 

  32. Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763

    Article  PubMed  CAS  Google Scholar 

  33. Ueno H, Mochizuki H, Hashiguchi Y, Hase K (2001) Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 234:190–197

    Article  PubMed  CAS  Google Scholar 

  34. Georgiou P, tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053–1062

    Article  PubMed  Google Scholar 

  35. Aoyama H, Maruta M, Maeda K, Okamoto N, Kato K, Katada K (2004) Chokuchougan rinpasetsuteni ni taisuru multi-slice CT shindan. A Monthly Journal of Medical Imaging and Information 36:161–165 (in Japanese)

    Google Scholar 

  36. Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J et al (1994) Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum 37:219–223

    Article  PubMed  CAS  Google Scholar 

  37. Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP et al (1999) Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 211:215–222

    PubMed  CAS  Google Scholar 

  38. Kulinna C, Scheidler J, Strauss T, Bonel H, Herrmann K, Aust D et al (2004) Local staging of rectal cancer. Assessment with double-contrast multislice computed tomography and trans rectal ultrasound. J Comput Assist Tomogr 28:123–130

    Article  PubMed  Google Scholar 

  39. Maier AG, Barton PP, Neuhold NR et al (1997) Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation. Radiology 203:785–789

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kustukake-cho, Toyoake, Aichi, 470-1192, Japan

    Harunobu Sato, Koutarou Maeda & Morito Maruta

Authors
  1. Harunobu Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koutarou Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Morito Maruta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harunobu Sato.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 45 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sato, H., Maeda, K. & Maruta, M. Prognostic significance of lateral lymph node dissection in node positive low rectal carcinoma. Int J Colorectal Dis 26, 881–889 (2011). https://doi.org/10.1007/s00384-011-1170-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1170-3

Keywords

Search

Navigation