This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Lateral pelvic lymph node dissection for advanced lower rectal cancer. BJS 2003; 90: 1580-1585.
Published: 3rd November 2003
Authors: S. Fujita, S. Yamamoto, T. Akasu, Y. Moriya
Background
The oncological outcome of patients who underwent curative surgery for lower rectal cancer was investigated to clarify whether lateral pelvic lymph node dissection (LPLD) conferred any benefit.
Method
A total of 246 patients who underwent curative surgery for stage II and III lower rectal cancer (below the peritoneal reflection) between 1985 and 1998 was reviewed. Forty‐two of these patients did not undergo LPLD.
Results
Patients who did not undergo LPLD were older, more likely to have anterior resection and pelvic nerve preservation, and had smaller tumours and lymph node metastasis at an earlier stage than those who underwent LPLD. There was no difference in survival among patients with stage II and III disease between the two groups. However, in patients with pathological N1 lymph node metastasis, the 5‐year disease‐free survival rate was 73·3 per cent in patients who had LPLD compared with 35·3 per cent among those who did not (P = 0·013). Multivariate analysis showed that LPLD was a significant prognostic factor.
Conclusion
LPLD improved the prognosis of patients with stage III disease and a small number of lymph node metastases. A randomized clinical trial is needed to verify the benefit of LPLD. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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