Radical lymph node resection of the retroperitoneal area for left-sided colon cancer

BACKGROUND/AIMS: Radical lymph node resection of the retroperitoneal area for cancer of the left half of the colon has been strongly questioned. The purpose of the study was to investigate the effect of extended lymph node resection of the retroperitoneal area in left-sided colon cancer. MATERIALS AND METHODS: From 1993 to 2002, 124 patients with left-sided colon cancer were randomly elected to undergo either conventional left colectomy (62 patients) or left colectomy combined with radical lymphadenectomy (62 patients). Clinical features were correlated to survival, recurrences, hospital mortality, morbidity, and late urogenital morbidity. Survival was the end point of the study. RESULTS: The groups were comparable for age, gender, physical status, TNM stage, tumor distribution, degree of differentiation, postoperative complications, chemotherapy, recurrences, sites of recurrence, and late urogenital morbidity (p > 0.05). Hospital mortality was higher in conventional surgery group (p = 0.008). Survival rates of 5 and 10 years did not differ significantly between the two groups (p > 0.05), although there was a trend of improvement after radical lymphadenectomy. Stage III patients in radical lymphadenectomy group had significantly better survival over those in the conventional surgery group (p = 0.0406). CONCLUSIONS: Radical lymph node resection of the retroperitoneal area is associated with the same rate of hospital morbidity, late urogenital morbidity, and total survival as is conventional surgery. It seems that there is a trend for improvement of survival particularly in stage III patients.