Survival Benefit of Japanese Extended Lymphadenectomy for Clinically Node-Negative and Node-Positive Colorectal Cancers

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Abstract

BACKGROUND:

The impact of extended lymphadenectomy for colorectal cancer is still not sufficiently clear.

OBJECTIVE:

The aim of the present study was to evaluate the survival benefit of extended lymphadenectomy compared with nonextended lymphadenectomy for clinically node-negative and node-positive colorectal cancers.

DESIGN:

The present study was a retrospective cohort study that used prospectively collected data and a propensity score matching method.

SETTINGS:

The present study was conducted at a single specialized colorectal surgery department.

PATIENTS:

Of the 1314 patients who underwent radical resection with nonextended or extended lymphadenectomy between 1988 and 2007, we included 711 and 603 patients in the cN0 and cN1/2 series. Propensity score matching was applied, and 141 and 63 pairs were extracted from the cN0 and cN1/2 series.

MAIN OUTCOME MEASURES:

Disease-free survival, cancer-specific survival, and overall survival of the 2 groups were calculated and compared.

RESULTS:

In the cN0 series, no differences were observed in the long-term outcomes between the nonextended and extended groups. In the cN1/2 series, the disease-free survival tended to be higher, and the cancer-specific survival and overall survival were significantly higher (log rank, p = 0.04, p = 0.02, and p = 0.01, respectively), but the frequency of local recurrence was significantly lower (p = 0.04) in the extended group.

LIMITATIONS:

The present study was limited by its nonrandomized retrospective design.

CONCLUSIONS:

Extended lymphadenectomy demonstrated a good inhibitory effect on the local recurrence rate and led to improved disease-free survival, cancer-specific survival, and overall survival of patients in the cN1/2 series. See Video Abstract at http://links.lww.com/DCR/A517.

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