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.
Department of Surgery, University of Tokyo Hospital, the Cancer Institute Hospital, Japan.
Toshiaki
T
Watanabe
Giichiro
G
Tsurita
Tetsuichiro
T
Muto
Toshio
T
Sawada
Koki
K
Sunouchi
Yoshiki
Y
Higuchi
Yasuhiro
Y
Komuro
Takamitsu
T
Kanazawa
Takeru
T
Iijima
Michiko
M
Miyaki
Hirokazu
H
Nagawa
D000230:Adenocarcinoma / Q000235:genetics / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D000368:Aged; D002886:Chromosomes, Human, Pair 17; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D016158:Genes, p53; D006801:Humans; D019656:Loss of Heterozygosity; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000235:genetics / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D016159:Tumor Suppressor Protein p53