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

Abstract

Summary: We clarify the significance of total mesorectal excision (TME), lateral lymphadenectomy (LLA), and of autonomic nerve preservation (ANP) compared to conventional surgery (CVS), for lower rectal cancer. All 458 patients curatively resected between 1962 and 1997 were retrospectively investigated. In Period I from 1962-1974, when CVS only was performed, in Period II from 1975-1984, THE or THE+LLA was performed, and in Period III from 1985-1997, THE+ANP, THE+ANP+LLA, or THE+LLA was performed. In Dukes A+B disease, there was no significant difference among the three periods, regardless of operation methods. In Dukes C disease, in Period I, CVS (42 patients: pts) had a local recurrence (LR) rate of 45.2% and 5-year disease-free survival (5YDFS) rate of 33.3%. In Period II, THE+LLA (82 pts) had a lower LR rate of 26.8% (p=0.0628) and higher 5YDFS 51.0% (p<0.05) vs CVS. In Period III, THE+ANP (12 pts) had LR 25.0% and 5YDFS 55.6%, TME+ANP+LLA (45 pts) had LR 13.3% (p<0.005, vs CVS) and 5YDFS 56.1 % (p<0.01, vs CVS), and THE+LLA (18 pts) had LR 16.7% (p<0.05, vs CVS) and 5YDFS 20.8%. Also, CVS had the lowest curability rate 64.8% and the highest mortality rate 7.2%. THE and/or LLA was significant for reducing LR and improving survival in patients with Dukes C lower rectal cancer, compared to CVS. ANP was beneficial with LLA. THE+ANP was suitable for Dukes A or B disease.

Indication and Benefit of Pelvic Sidewall Dissection for Rectal Cancer

“…However, the subgroup of patients with positive LLN can survive for more than five years after PSD. The reported five-year survival rates of patients with positive LLN ranged from 37.3 to 49.3 percent in each institute study, 31,32,[36][37][38][39][40] and the present study, which included a large number of patients, also showed the rate of 45.8 percent (Table 6).…”

“…Table 6 summarizes the studies of PSD and positive LLN reported since 1996. [36][37][38][39][40] All except two 31,32 analyzed. The greater incidence of positive LLN of lower rectal cancer was observed by Ueno et al 40 and in this study.…”

Surgical specialization and training – its relation to clinical outcome for colorectal cancer surgery

“…Shirouzu et al . from Japan compared local recurrence and survival after surgery using TME and BD with or without lateral lymphadenectomy (LLA), autonomic nerve preservation (ANP) or both [51]. Their results found that patients with Duke C cancer showed improvement with TME alone or in combination with LLA/ANP; 5‐year disease‐free survival also improved.…”

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

“…Lateral pelvic lymphadenectomy for advanced low rectal cancer is controversial [19][20][21][22][23][24][25] . In Japan, lateral pelvic lymphadenectomy is routinely performed for patients with advanced low rectal cancer, whereas it is not frequently performed in the Western countries [26][27][28] .…”