PREVENTION OF LOCAL RECURRENCE BY EXTENDED LYMPHADENECTOMY FOR RECTAL-CANCER

被引:56
作者
SUZUKI, K [1 ]
MUTO, T [1 ]
SAWADA, T [1 ]
机构
[1] UNIV TOKYO,DEPT SURG,BUNKYO KU,TOKYO 113,JAPAN
来源
SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY | 1995年 / 25卷 / 09期
关键词
RECTAL CANCER; LOCAL RECURRENCE; EXTENDED LYMPHADENECTOMY; LOCAL RECURRENCE RATE; LATERAL NODE METASTASIS;
D O I
10.1007/BF00311455
中图分类号
R61 [外科手术学];
学科分类号
摘要
This study was undertaken to determine if the degree of lymphadenectomy correlates with the prevention of local recurrence. The authors retrospectively reviewed the clinical data of 269 patients who underwent curative surgery for rectal cancer. The study was divided into three periods based on the method of lymphadenectomy as follows: period I (1963-1979) when extended lymphadenectomy was not performed; period II (1980-1985) when this was partially done with no attempt to dissect the obturator and proximal middle rectal lymph nodes; and period III (1986-1990) when this was completely performed for patients with appropriate indications. The local recurrence rates were 21%, 10%, and 8% for Periods I, II, and III, respectively (P < 0.05). The incidence of local recurrence tended to be greater in period I versus periods II and III according to type of operation, location, and stage of the primary tumors. The local recurrence rates arising from lateral node metastases were 11%, 4%, and 2% for periods I, II, and III, respectively (P < 0.05), while the incidence related to an insufficient surgical margin was approximately 5% throughout the three periods. We thus conclude that the degree of lymphadenectomy is a major determinant of local recurrence following a curative operation for rectal cancer.
引用
收藏
页码:795 / 801
页数:7
相关论文
共 28 条
[1]  
Morson B.C., Vaughan E.G., Bussey H.J.R., Pelvic recurrence after excision of rectum for carcinoma, BMJ, 2, pp. 13-18, (1963)
[2]  
Secco G.B., Fardelli R., Campora E., Rovida S., Bertoglio S., Factors influencing local recurrence after curative surgery for rectal cancer, Oncology, 46, pp. 10-13, (1989)
[3]  
Phillips R.K.S., Hittinger R., Blesovsky L., Fry J.S., Fielding L.P., Local recurrence following “curative” surgery for large bowel cancer: I. The overall picture, Br J Surg, 71, pp. 12-16, (1984)
[4]  
Quirke P., Durdey P., Dixon M.F., Willia N.S., Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision, Lancet, 1, pp. 996-999, (1986)
[5]  
Michelassi F., Block G.E., Vannucci L., Montag A., Chappell R., A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma, Ann Surg, 208, pp. 379-389, (1988)
[6]  
Welch J.P., Donaldson G.A., Detection and treatment of recurrent cancer of the colon and rectum, Am J Surg, 135, pp. 505-511, (1978)
[7]  
Willia N.S., The rationale for preservation of the anal sphincter in patients with low rectal cancer, Br J Surg, 71, pp. 575-581, (1984)
[8]  
Enker W.E., Heilweil M.L., Hertz R.E.L., Pilipshen S.J., Stearns M.W., Sternberg S.S., Janov A.J., En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer, Ann Surg, 203, pp. 426-433, (1986)
[9]  
Gunderson L.L., Sosin H., Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum, Cancer, 34, pp. 1278-1292, (1974)
[10]  
Heald R.J., Ryall R.D.H., Recurrence and survival after total mesorectal excision for rectal cancer, Lancet, 1, pp. 1479-1482, (1986)