Lumboaortic and iliac lymphadenectomy:

Abstract

Five-year survival was 70.6 percent in patients with no lymph node involvement, 68.2 percent in patients with pararectal lymph nodes N+, 25 percent in patients with involvement of intermediate lymph nodes, and 30 percent in patients with involvement of lumboaortic lymph nodes. In no case was there involvement of the hypogastric lymph nodes. On the basis of our experience and from results in the literature, we consider an upward extended lymphadenectomy with high ligation of the inferior mesenteric artery is warranted since it enables the tumor to be staged accurately and may lead to survival even in cases of advanced lymph node involvement.

High Tie of the Inferior Mesenteric Artery in Curative Surgery for Left Colonic and Rectal Cancers: A Systematic Review

“…Similar results were reported on 252 patients who underwent curative surgery for rectal cancer at the University of Trieste, Italy [35]. In all cases the IMA was ligated high, and all lumbo-aortic lymph nodes were cleared.…”

“…However, most of these studies originate in Japan, where IMA high tie is often combined with lateral pelvic lymphadenectomy, which makes interpretation of results difficult. The reported 40% 5-year survival rate for patients with Dukes’ C2 tumours has been replicated in two European series [35, 36], but whether this can be widely matched remains to be seen. While there is no unequivocal evidence of improved survival directly attributable to IMA high tie, in the majority of published studies patients who underwent this procedure had better survival rates [15, 17, 21], but with one exception [15], the observed difference was not statistically significant.…”

“…Furthermore, a study comparing tissue oxygenation proximal to the colonic resection margin demonstrated that the marginal artery provides an adequate vascular supply to the transverse and descending colon [49], thus explaining the low anastomotic leak rates reported after high IMA ligation [39, 45, 46, 50]. Although the superior hypogastric nerves are at risk, ligation of the IMA at its origin is the safest option in order to avoid damage to the autonomic nerves [51, 52], which permits preservation of sexual and urinary functions in the great majority of the patients [35, 36, 53]. …”

Long-term benefits of aggressive treatment for primary colorectal cancer

“…Other, smaller series have given similarly disappointing results with radical aortic lymphadenectomies performed for mid-and low-rectal cancers [24,35]. Thus, although certain authors believe that there may be a possible therapeutic benefit of aortic lymphadenectomies for such tumors [ 19,22,[25][26][27][28]33,34], this benefit, if any, may be of insufficient magnitude to be detected in a reasonably sized, randomized trial. Such high aortic lymphadenectomies were not carried out in this series for mid-and low-rectal cancers.…”

“…Several retrospective reports do suggest however, that wide removal of the lymph node basins adjacent to colorectal cancers may confer a considerable survival benefit [15][16][17][18][19][20][21][22]34,39,, although others dispute this claim [5,24,38,60]. In the present study, there was a suggestion of an improved overall 5-year survival for the Dukes' stage B and C patients who had scrupulous clearance of the primary nodal basins adjacent to the cancer, when compared to similarly staged patients undergoing standard resection (P <0.04) ( Table I, Fig.…”