Indication for Lateral Lymphnodal Dissection for Rectal Cancer, as Seen from Cases of Disease-free Survival

Abstract

In 352 cases on lateral dissection for advanced monorectal cancer, incidence of lateral metastasis and the effect of dissection were examined and the indication for lateral dissection as seen from cases of disease-free survival was considered. Of 43 cases of lateral metastasis, 13 (wall depth mp 4, a₁·ss 5 and a₂·se 4) represented disease-free survival and 12 represented Ra lower anal curative resection, metastatic lymphnodes and regions were limited to less than 4 and 2, respectively. There were 12 cases of upward-metastases up to n1 and 1 case of No. 252 jumping metastasis. Risk factor for unilateral dissection was about 30%. Indication for lateral dissection was regarded as such curatively resectable cases as have Ra lower anal occupied region and above mp-wall depth as well as exactly dissectable (bilateral No. 262·No. 272) domain. Occasionally for cases in which the tumor inferior margin reaches the dental line, No. 292 dissection should also be performed Of 22 cases of lateral metastasis in this indication, 12 cases (54.5%) represented disease-free survival, and only 1 off-indication case was disease-free survival.