Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer |
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Authors: | Kenichi Sugihara MD Hirotoshi Kobayashi MD Tomoyuki Kato MD Takeo Mori MD Hidetaka Mochizuki MD Shingo Kameoka MD Kazuo Shirouzu MD Tetsuichiro Muto MD |
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Institution: | (1) Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;(2) Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;(3) Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan;(4) Department of Surgery, National Defense Medical College, Saitama, Japan;(5) Second Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan;(6) Department of Surgery, Kurume University, School of Medicine, Fukuoka, Japan;(7) Department of Surgery, Cancer Institute Hospital, Tokyo, Japan |
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Abstract: | 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.
Study Group for Rectal Cancer Surgery of the Japanese Society for Cancer of the Colon and Rectum.
Presented at the United States-Japan Clinical Trial Summit Meeting, Maui, Hawaii, February 10–13, 2005. |
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Keywords: | Rectal cancer Pelvic sidewall dissection Lateral lymph node |
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