[Anterior resection in rectal cancer: the role of lymphadenectomy. Comparison of 2 surgical experiences].

: Of great interest today is the debate regarding the benefits and limitations of extended lymphadenectomy in rectal cancer, particularly with regard to patient survival. In the present report we review the experience of two different surgical departments: a total of 458 patients with rectal cancer were operated on in the 1st Surgical Department of S. Martino Hospital, Genoa, and in the 1st Surgical Department of Galliera Hospital, Genoa over the period from 1980 to 1989. Anterior rectal resection was performed in 137 rectal tumours at the S. Martino Hospital and in 146 at the Galliera Hospital. The mean follow-up was 48 months (range: 24-120 months). In the first group of patients, ligation at the origin of the mesenteric vessels (with subsequent peri-aortic lymphadenectomy) (D2-D3) was performed, while in the second group the mesenteric vessel ligation was done at the level of the origin of the left colic vessels (D1). There were no complementary therapies (radio or chemotherapy) either before or after surgery, because these were only introduced later. The data obtained from analysis of the long-term survival curves showed that there were no statistical differences between the two surgical experiences. The execution of extended lymphadenectomy would not appear to afford any additional benefit in terms of the survival of patients with rectal cancer. The well-matched starting conditions in the two groups allowed effective comparison between the two experiences and evaluation of the "pure" surgical aspect.