title: Impact of upward lymph node dissection on survival rates in advanced lower rectal carcinoma.
abstract: OBJECTIVE
  This study investigated appropriate level of upward lymph node (LN) dissection in advanced lower rectal carcinoma.
  
  
  METHODS
  A total of 285 consecutive patients with stage II/III lower rectal carcinoma were analyzed. LN dissection was classified as follows: division of the root of the superior rectal artery (UD2), division of the root of the inferior mesenteric artery (UD3) and UD3 with para-aortic LN dissection (UD4).
  
  
  RESULTS
  LN metastases at the root of the inferior mesenteric artery were found in 4 patients. Their prognoses were worse than those of the other stage III patients (p = 0.011). On the other hand, LN metastases along the superior rectal artery were discovered in 14 patients, whose 5-year overall survival rate was 61.2%. By removing the LNs either UD2 or UD3/4, a similar survival rate was achieved in stage III patients with LN metastases along the superior rectal artery.
  
  
  CONCLUSIONS
  Survival of a minority with metastatic LNs at the root of the inferior mesenteric artery was poor. Additionally, survival is no worse in patients with positive LN along the superior rectal artery as long as these positive nodes are resected by either UD2 or UD3/4. Low ligation is adequate for advanced lower rectal carcinoma.
authors.affiliation: Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Uehara
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shin
authors.initials: S
authors.lastname: Fujita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Akasu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriya
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors