title: Extended lymphadenectomy for locally advanced and recurrent rectal cancer.
abstract: OBJECTIVE
  The purpose of this study is to assess the value of extended (lateral) lymphadenectomy (EL) in the operative management of locally advanced and recurrent rectal cancer.
  
  
  METHODS
  Patients that underwent exenterative surgery for locally advanced or recurrent rectal cancer between 2006 and 2009 were included in the study. A decision for EL was taken at the local multidisciplinary meeting based on the radiological findings. Perioperative and oncological outcomes were assessed and compared between the EL and non-EL group prospectively.
  
  
  RESULTS
  Forty-one consecutive patients were included in the study (EL = 17). The median age was 57 (40-71) for EL and 66 (39-81) years for non-EL. Of patients, 27 (EL = 13) and 14 (EL = 4) underwent pelvic exenteration and abdominosacral resection, respectively. Twelve (EL = 7) patients were diagnosed with locally advanced primary rectal cancer. Thirty-one (EL = 12) patients received neoadjuvant radiotherapy. The median intraoperative time, blood loss and hospital stay were 9 h (3-13), 1.5 l (0.3-7) and 14 days (12-72), respectively, for the EL group, and 8 h (4-15), 1.6 l (0.25-17) and 14 days (10-86), respectively, for the non-EL (p ≥ 0.394). Morbidity was similar between the two groups (EL = 4, non-EL = 9; p = 0.344). Complete tumour resection (R0) was achieved in 30 (73.17%) patients, 12 (70.58%) in the EL group and 18 (75%) in the non-EL group (p = 0.649). There was no significant difference in 5-year survival (EL = 60.7%, non-EL = 75.2%; p = 0.447), local recurrence (EL = 53.6%, non-EL = 65.4%; p = 0.489) and disease-free survival (EL = 53.6%, non-EL = 51.4%; p = 0.814).
  
  
  CONCLUSIONS
  The present study demonstrated that EL does not provide a statistically significant advantage in survival or recurrence rates, for patients with locally advanced primary or recurrent rectal cancer.
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK.|Department of Surgery and Cancer, Academic Surgery, Imperial College, 3rd Floor, Chelsea and Westminster Hospital Campus, Fulham Road, SW10 9NH, London, UK.
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Georgiou
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK.|Department of Surgery and Cancer, Academic Surgery, Imperial College, 3rd Floor, Chelsea and Westminster Hospital Campus, Fulham Road, SW10 9NH, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mohammed Ali
authors.affiliation: Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK.|Department of Surgery and Cancer, Academic Surgery, Imperial College, 3rd Floor, Chelsea and Westminster Hospital Campus, Fulham Road, SW10 9NH, London, UK.
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Rasheed
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK. p.tekkis@imperial.ac.uk.|Department of Surgery and Cancer, Academic Surgery, Imperial College, 3rd Floor, Chelsea and Westminster Hospital Campus, Fulham Road, SW10 9NH, London, UK. p.tekkis@imperial.ac.uk.
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D019990:Perioperative Care; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Advanced; Exenterative surgery; Extended; Lateral; Locally; Lymphadenectomy; Pelvic sidewall; Rectal cancer; Recurrent