Extended lymphadenectomy for recurrent and locally advancedprimary rectal cancer: LTP23


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Abstract

Aim:To assess the value of extended (lateral) lymphadenectomy (EL) in the operative management of recurrent and locally advancedprimary rectal cancer.Method:Patients undergoing exenterative surgery, between 2006 and 2009, for recurrent or locally advancedprimary rectal cancer were included. Peri-operative outcomes, survival and recurrence rates were assessed and compared between the two groupsprospectively.Results:Forty-three consecutive patients were included (EL = 18, non-EL = 25). The median age was 57 (40-70) for EL and 66 (39-81) years for non-EL. Twenty-eight (EL = 13) patients underwent pelvic exenteration and 15 (EL = 5) abdominosacral resection. Twelve (EL = 7) patients had locally advancedprimary rectal cancer. Thirty-three (EL = 13) patients had neo-adjuvant radiotherapy. The median intra-operative time, blood loss and hospital stay were 9 (3-13) hours, 1.2 (0.3-5) litres and 14 (12-72) days respectively for EL, whereas for non-EL were 8 (3-15) hours, 1.5 (0.25-17) litres and 14 (10-86) respectively (P > 0.380). Complete tumour resection (R0) was achieved in 30 (EL = 13) patients. Local recurrence was diagnosed in four and five patients (P = 0.812) and distant recurrence in three and seven patients (P = 0.411) in the EL and non-EL group respectively. All recurrences occurred within 22 months. There was no significant difference in 3-year survival (HR = 0.36, P = 0.34).Conclusion:This study demonstrated that EL does notprovide a significant oncological advantage, for patients with recurrent or locally advancedprimary rectal cancer.

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