Role of extended lymph node dissection in the treatment of gastrointestinal tumours: a review of the literature.
Over recent decades the long-term survival of patients operated on for gastrointestinal cancer has shown little if any improvement, despite sometimes aggressive surgical procedures and a significant fall in postoperative mortality.


BACKGROUND
We went through the literature to see if there were any eventual effects of extended lymph node dissection or survival.


METHODS
We reviewed recent literature on the different types of gastrointestinal cancer.


RESULTS
Japanese centres report excellent results when wide local excision is combined ith systematic extended lymph node dissection, especially in gastric and oseophageal cancer. The overall 5-year survival of over 50% for the large number of patients undergoing gastric resection for cancer seems to demonstrate convincingly the value of the extended lymphadenectomy. All oriental studies are uncontrolled, as are most reports from Western countries. The role of extended lymphadenectomy is therefore far from certain. The results from two randomized studies (British Medical Research Council and Dutch Gastric Cancer Trial) are awaited. It is evident from these prospective studies that the procedure adds a considerable operative risk. From non-randomized studies there is evidence that extended lymph node dissection in the treatment of pancreatic cancer might be of benefit to patients with small stage I and II tumours. In the treatment of proximal bile duct cancer the main goal of surgery is optimal relief of biliary obstruction. Whether there will ever be a role for extensive lymphadenectomy is doubtful. The extent of the surgical procedure in the treatment of gallbladder cancer is related to the depth of tumour infiltration. Extended resections are only recommended for patients with stage II to IV tumours. Extended lateral pelvic node dissection in the treatment of rectal cancer is demonstrated in Japanese retrospective studies to induce considerable urogenital problems, whereas the risk for local recurrence is still present.


CONCLUSIONS
No firm conclusions can be drawn based on data as available from the studied literature. Trial results will have to be awaited. Specific subgroups such as gastric and rectal cancer might benefit from these more extensive procedures.
Taat
C W
CW
Dept. of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
van Laschot
J J
JJ
Gouma
D J
DJ
Obertop
H
H
D001650:Bile Duct Neoplasms / Q000601:surgery; D002986:Clinical Trials as Topic; D003110:Colonic Neoplasms / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D005069:Evaluation Studies as Topic; D005706:Gallbladder Neoplasms / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome