The Pros and Cons of Lymphadenectomy in Association with Rectal Excision for Carcinoma of the Rectum

Abstract

A clinical study was carried out in 717 resected cases of rectal carcinoma. Abdomino-perineal excisions were performed in 75% of the cases and low anterior resection in 25%. Regional lymph nodes were divided into 3 groups (N1, N2 and N3), and operative grades were classified as R1, R2 and R3 according to complete dissection of the corresponding lymph node groups. The 5-year survival rate was 48.8% in the Rl grade, 58.7% in R2 and 67.7% in R3. Even within each stage of cancer advance, the 5-year survival rate was better, as lymphadenectomy was more extensive. Local recurrence within 5 years after rectal surgery occurred in 28% of the cases in the R1 grade, in 19% of R2 and in 10.7% of R3 patients. The rate of urinary disturbance was 6.1, 24.5 and 27.5%, respectively. The rate of sexual dysfunction was 38.2, 68.1 and 76.7%, respectively. Statistically there was no significance in each of the factors mentioned above between abdomino-perineal excision and low anterior resection, but there was a significant difference between the R1 and R3 grade. Extensive lymphadenectomy is indicated for advanced cancer of the rectum, but a more careful maneuver is mandatory in order to protect the pelvic nerves.