An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy

Abstract

Records of four hundred thirty-seven patients with lower and middle rectal cancer who underwent resection for cure at National Cancer Center Hospital from 1969 to 1983 were reviewed. There were significantly lower recurrence rates in the extended excision group compared with the conventional excision group. The recurrence rates between these two groups with Dukes' A were 0 percent (0 of 23) vs. 5.2 percent (5 of 96), those with Dukes' B were 6.3 percent (5 of 80) vs. 21.9 percent (14 of 64), Dukes' C were 23.6 percent (20 of 89) vs. 32.8 percent (28 of 85). The differences between the two groups with Dukes' B and C were statistically significant (P less than .05). The cumulative five-year survival rates in the extended excision group were 94 percent with Dukes' A stage, 88 percent with Dukes' B stage, and 61 percent with Dukes' C stage, compared with 91 percent (Dukes' A), 74 percent (Dukes' B), and 43 percent (Dukes' C) in the conventional excision group. There were also statistically significant differences between the two groups with Dukes' B and C stages (P less than .05). Although wide iliopelvic lymphadenectomy was successful as far as decreasing the incidence of local recurrence and also in prolonging survival, there were increased incidences of urine-voiding failure (loss of sense of bladder being full of urine detected in 39.4 percent of the extended excision group vs. 8.8 percent of the conventional excision group) and sexual impotency (76 percent vs. 37.5 percent).

Total Mesorectal Excision, Lateral Lymphadenectomy and Autonomic Nerve Preservation for Lower Rectal Cancer: Significance in the Long-term Follow-up Study.

“…Therefore, lateral lymphadenectomy (LLA) (sometimes termed pelvic lymphadenectomy or extended surgery) was performed between the early 1970s and the mid 1980s. The significance and benefit of LLA were debated and supported for a long time in Japan, and even the colorectal specialists at the National Cancer Center Hospital of Japan reported the significance of LLA to improve the survival rate and decrease LR [13][14][15][16] . This surgical technique was therefore widely practiced in Japan with the aim of ultimate radical cure.…”

Evaluation of the lateral sentinel node by indocyanine green for rectal cancer based on micrometastasis determined by reverse transcriptase-polymerase chain reaction

“…This procedure is associated with a lower local recurrence rate than conventional surgery. However, due to the high incidence of complications with LPLD, including sexual and urinary dysfunction (8), and the poor prognosis of patients with lateral LN metastasis (5-year survival rate, 38-42%) (7,24,25), this operation has only been performed in Japan. As a result, it is necessary to restrict the indications of LPLD for advanced lower rectal cancer.…”

“…Although many trials consisting of extended surgery, adjuvant chemotherapy and radiotherapy were carried out to prevent local recurrence after curative surgery, no significantly favorable results have yet been reported. Since the early 1980s, the results of a lateral pelvic LN dissection (LPLD) for rectal cancer have improved steadily, although LPLD performed in Japan at that time often caused urinary and sexual dysfunction (7,8). Since the beginning of the mid 1980s, colorectal surgeons in Japan have sought to improve their surgical techniques to either alleviate or prevent functional disturbances and to individualize the operative procedures according to the local extent of the cancer without increasing the risk of local recurrence.…”

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

“…Extensive bilateral resection of the inferior hypogastric plexus leads to a neurogenic bladder in 78 % of patients in the third postoperative week, in 58% of patients spontaneous voluntary evacuation was not restored after 2 months (59). After unilateral resection the majority of patients can urinate spontaneously again only after 2 months.…”

“…After unilateral resection the majority of patients can urinate spontaneously again only after 2 months. (59,99). Vesicourethral dysfunction occurs after LAR and APE in the early post-operative phase in 30 -70 % of patients if the autonomic nerves are not specifically preserved or cannot be correctly identified in an effort to preserve the nerves (1,76,77) Obstructive disorders after surgery attract more attention as they have to be treated acutely, although continence disorders are also common.…”