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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 11/2006

01-11-2006 | Original Contributions

Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer

Authors: Kenichi Sugihara, M.D., Hirotoshi Kobayashi, M.D., Tomoyuki Kato, M.D., Takeo Mori, M.D., Hidetaka Mochizuki, M.D., Shingo Kameoka, M.D., Kazuo Shirouzu, M.D., Tetsuichiro Muto, M.D.

Published in: Diseases of the Colon & Rectum | Issue 11/2006

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Purpose

This study was designed to clarify indication and benefit of pelvic sidewall dissection for rectal cancer.

Methods

The retrospective, multicenter study collected the data of rectal cancer patients who underwent surgery between 1991 and 1998 and were prospectively followed.

Results

Of 1,977 patients with rectal cancers, 930 underwent pelvic sidewall dissection without adjuvant radiotherapy. Positive lateral lymph nodes were found in 129. Multivariate analysis disclosed a significantly increased incidence of positive lateral lymph nodes in female gender, lower rectal cancers, non-well-differentiated adenocarcinoma, tumor size of ≥4 cm and T3-T4. The five-year survival rate for 1,977 patients was 79.7 percent. The survival of patients with positive lateral lymph nodes was significantly worse than that of Stage III patients with negative lateral lymph nodes (45.8 vs. 71.2 percent, P<0.0001). Multivariate analysis showed significantly worse prognosis in male gender, pelvic sidewall dissection, lower rectal cancers, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes. During the median follow-up time of 57 months, recurrence developed in 19.7 percent: 17 percent in negative and 58.1 percent in positive lateral lymph nodes (P<0.0001). Local recurrence was found in 8 percent: 6.8 percent in negative and 25.6 percent in positive lateral lymph nodes (P<0.0001). Multivariate analysis disclosed that lower rectal cancers, non-well-differentiated adenocarcinoma, T3-T4, perirectal lymph node metastasis, and positive lateral lymph nodes were significantly associated with an increased local recurrence.

Conclusions

Positive lateral lymph node was the strongest predictor in both survival and local recurrence. Pelvic sidewall dissection may be indicated for patients with T3-T4 lower rectal cancers because of the greater provability of positive lateral lymph nodes.
Literature
1.
Dahl, O, Horn, A, Morild, I,  et al. 1990Low-dose preoperative radiation postpones recurrences in operable rectal cancer. Results of a randomized multicenter trial in western NorwayCancer6622862294PubMedCrossRef
2.
Marsh, PJ, James, RD, Schofield, PF 1994Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma. Results of a prospective, randomized trialDis Colon Rectum3712051214PubMedCrossRef
3.
Holm, T, Rutqvist, LE, Johansson, H, Cedermark, B 1995Abdominoperineal resection and anterior resection in the treatment of rectal cancer: results in relation to adjuvant preoperative radiotherapyBr J Surg8212131216PubMed
4.
Anonymous1996Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working PartyLancet34816051610CrossRef
5.
Anonymous1997Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer TrialN Engl J Med336980987CrossRef
6.
Treurniet-Donker, AD, Putten, WL, Wereldsma, JC, Bruggink, MD 1991Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in The NetherlandsCancer6720422048PubMedCrossRef
7.
Anonymous1996Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Medical Research Council Rectal Cancer Working PartyLancet34816101614CrossRef
8.
Arnaud, JP, Nordlinger, B, Bosset, JF,  et al. 1997Radical surgery and postoperative radiotherapy as combined treatment in rectal cancer. Final results of a phase III study of the European Organization for Research and Treatment of CancerBr J Surg84352357PubMedCrossRef
9.
Heald, RJ, Husband, EM, Ryall, RD 1982The mesorectum in rectal cancer surgery–the clue to pelvic recurrence?Br J Surg69613616PubMed
10.
Enker, WE 1992Potency, cure, and local control in the operative treatment of rectal cancerArch Surg12713961402PubMed
11.
Hojo, K, Koyama, Y, Moriya, Y 1982Lymphatic spread and its prognostic value in patients with rectal cancerAm J Surg144350354PubMedCrossRef
12.
Koyama, Y, Moriya, Y, Hojo, K 1984Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum–significant improvement of survival rate and decrease of local recurrenceJpn J Clin Oncol14623632PubMed
13.
Camma, C, Giunta, M, Fiorica, F,  et al. 2000Preoperative radiotherapy for resectable rectal cancer: a meta-analysisJAMA28410081015PubMedCrossRef
14.
Colorectal Cancer Collaborative Group2001Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trialsLancet35812911304CrossRef
15.
Enker, WE, Thaler, HT, Cranor, ML, Polyak, T 1995Total mesorectal excision in the operative treatment of carcinoma of the rectumJ Am Coll Surg181335346PubMed
16.
Leo, E, Belli, F, Andreola, S,  et al. 2000Total rectal resection and complete mesorectum excision followed by coloendoanal anastomosis as the optimal treatment for low rectal cancer: the experience of the National Cancer Institute of MilanoAnn Surg Oncol7125132PubMedCrossRef
17.
Law, WL, Chu, KW 2001Impact of total mesorectal excision on the results of surgery of distal rectal cancerBr J Surg8816071612PubMedCrossRef
18.
Kapiteijn, E, Marijnen, CA, Nagtegaal, ID,  et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRef
19.
Tocchi, A, Mazzoni, G, Lepre, L,  et al. 2001Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrencesArch Surg136216220PubMedCrossRef
20.
Vironen, JH, Halme, L, Sainio, P,  et al. 2002New approaches in the management of rectal carcinoma result in reduced local recurrence rate and improved survivalEur J Surg168158164PubMedCrossRef
21.
Bulow, S, Christensen, IJ, Harling, H,  et al. 2003Recurrence and survival after mesorectal excision for rectal cancerBr J Surg90974980PubMedCrossRef
22.
Wibe, A, Syse, A, Andersen, E, Tretli, S, Myrvold, HE 2004Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resectionDis Colon Rectum474858PubMedCrossRef
23.
Heald, RJ, Moran, BJ, Ryall, RD,  et al. 1998Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997Arch Surg133894899PubMedCrossRef
24.
Zaheer, S, Pemberton, JH, Farouk, R,  et al. 1998Surgical treatment of adenocarcinoma of the rectumAnn Surg227800811PubMedCrossRef
25.
Hainsworth, PJ, Egan, MJ, Cunliffe, WJ 1997Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancersBr J Surg84652656PubMedCrossRef
26.
Lopez-Kostner, F, Lavery, IC, Hool, GR,  et al. 1998Total mesorectal excision is not necessary for cancers of the upper rectumSurgery124612618PubMedCrossRef
27.
Hahnloser, D, Pemberton, JH 2003Total mesorectal excision for all rectal cancers [editorial]Surgery1336667PubMedCrossRef
28.
Akasu, T, Moriya, Y 1997Abdominopelvic lymphadenectomy with autonomic nerve preservation for carcinoma of the rectumLippincott-RavenPhiladelphia
29.
30.
Harnsberger, JR, Vernava, VM,3rd, Longo, WE 1994Radical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical management of rectal cancerDis Colon Rectum377387PubMedCrossRef
31.
Sugihara, K, Moriya, Y, Akasu, T, Fujita, S 1996Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcomeCancer7818711880PubMedCrossRef
32.
Mori, T, Takahashi, K, Yasuno, M 1998Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissectionLangenbecks Arch Surg383409415PubMedCrossRef
33.
Lowry, AC, Simmang, CL, Boulos, P,  et al. 2001Consensus statement of definitions for anorectal physiology and rectal cancer: report of the Tripartite Consensus Conference on Definitions for Anorectal Physiology and Rectal Cancer, Washington, D.C., May 1, 1999Dis Colon Rectum44915919PubMedCrossRef
34.
Japanese Society for Cancer of the Colon and Rectum1997Japanese classification of colorectal carcinomaKaneharaTokyo
35.
Canessa, CE, Miegge, LM, Bado, J, Silveri, C, Labandera, D 2004Anatomic study of lateral pelvic lymph nodes: implications in the treatment of rectal cancerDis Colon Rectum47297303PubMedCrossRef
36.
Moriya, Y, Sugihara, K, Akasu, T, Fujita, S 1997Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancerWorld J Surg21728732PubMedCrossRef
37.
Ueno, H, Mochizuki, H, Hashiguchi, Y, Hase, K 2001Prognostic determinants of patients with lateral nodal involvement by rectal cancerAnn Surg234190197PubMedCrossRef
38.
Shirouzu, K, Ogata, Y, Araki, Y,  et al. 2001Total mesorectal excision, lateral lymphadenectomy and autonomic nerve preservation for lower rectal cancer: significance in the long-term follow-up studyKurume Med J48307319PubMed
39.
Shimoyama, M, Yamazaki, T, Suda, T, Hatakeyama, K 2003Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2Dis Colon Rectum46333339PubMedCrossRef
40.
Ueno, M, Oya, M, Azekura, K,  et al. 2005Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancerBr J Surg92756763PubMedCrossRef
41.
Brown, G, Richards, CJ, Bourne, MW,  et al. 2003Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparisonRadiology227371377PubMed
42.
Matsuoka, H, Nakamura, A, Masaki, T,  et al. 2003Comparison between endorectal coil and pelvic phased-array coil magnetic resonance imaging in patients with anorectal tumorAm J Surg185328332PubMedCrossRef
Metadata
Title
Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer
Authors
Kenichi Sugihara, M.D.
Hirotoshi Kobayashi, M.D.
Tomoyuki Kato, M.D.
Takeo Mori, M.D.
Hidetaka Mochizuki, M.D.
Shingo Kameoka, M.D.
Kazuo Shirouzu, M.D.
Tetsuichiro Muto, M.D.
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 11/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0714-z

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