The role of lymphadenectomy in colorectal neoplasms

BACKGROUND: The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not only because it is deemed to be a basic element for a correct postoperative staging, but also because it brings about, according to some authors, an enhancement of survival and of "disease free survival" rates. The difficulty to collect case histories with homogeneous data and the impossibility to identify preoperatively with certainty the lymph nodes involved, makes it difficult to codify the most suitable surgical treatment, even if it is agreed at present, to extend lymph nodes dissection at least as far as Level II nodes. As a matter of fact, despite of slight enhancement of 5-year survival rate (6-8%), a significant increase in morbility occurs, as reported in the literature, particularly in terms of urological and neurological lesions. However, a few authors, perform systematically Level III dessection, reporting a 20% increase in survival. METHODS: Our study, has been carried out on 84 patients affected by large bowel neoplasm and admitted to the Institute of Surgical Pathology I of "Vittorio Emanuele" Hospital of Catania between 1990-1995. RESULTS: This study showed an involvement of Level I lymph nodes in 77% of patients and of Level II in 33%, while Level III nodes were affected only in 4.7% of cases. CONCLUSIONS: On the basis of these data and of those reported in the literature, the conclusion is drawn that the most suitable and responsible attitude is, at present, to perform invariably Level I and Level II dissection, reserving the lymphadenectomy of Level III only to selected cases or when an involvement is documented pre and intraoperatively.