Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers

Background. Extended lymphadenectomy including lateral node dissection (EXT-L) contributes to a low incidence of local recurrence of lower rectal cancer. However, EXT-L is frequently associated with impairment of sexual and urinary function. We therefore compared the effectiveness of preoperative radiotherapy with that of EXT-L. Methods. One hundred fifteen patients were studied. Seventy-eight patients underwent preoperative radiotherapy with a total dose of 50 Gy (Rad[+] group), and 37 did not (Rad[−] group). Seventy-five patients received EXT-L (EXT-L[+] group), and 40 did not (EXT-L[−] group). Patients were further divided into 4 subgroups (Rad[+]&EXT-L[−], Rad(+)&EXT-L[+], Rad[−]&EXT-L(+), and Rad[−]&EXT-L[−]), and clinicopathologic features were examined. In the Rad(+) group, the relation between the p53 gene and survival was also examined. Results. There was a significant difference in disease-free survival between the Rad(+) and Rad(−) groups (5-year disease-free survival rate, 74.6% vs 45.9%; P =.006). However, there was no significant difference between the Rad(+)&EXT-L[−] and Rad[−]&EXT-L(+) groups. The p53 gene status did not affect survival in the Rad(+) group. Conclusions. This study suggests that in terms of curative effect, preoperative radiotherapy can be one alternative therapy in place of EXT-L for patients with lower rectal cancer. (Surgery 2002;132:27-33.)