Researchers from the UK have reported that extended lymphadenectomy for rectal cancer may not improve outcomes and may increase the risk of urinary and sexual dysfunction. The details of this study appeared in an early online publication in Lancet Oncology on September 20, 2009.[1]

Patients with rectal cancer have lateral pelvic lymph-node involvement in 10-25% of cases. This leads to an increased rate of relapses compared with patients with negative nodes. However, the impact of extensive surgical removal of lymph nodes is not clear, especially in the setting of neoadjuvant and adjuvant radiotherapy and chemotherapy.

Researchers involved in the current study performed meta-analyses of 20 studies involving over 5,000 patients who did or did not have extended lymphadenectomy for rectal cancer. One study was randomized, and the remainder was non-randomized. 2,577 patients underwent extended lymphadenectomy, and 2,925 did not. Operating time was significantly longer, and blood loss was significantly greater for the extended lymphadenectomy group. Perioperative mortality and morbidity was similar between the two groups. However, male urinary and sexual dysfunction was greater in the extended lymphadenectomy group. There were no significant differences in five-year overall survival, disease-free survival, local recurrences or distant recurrences between the two groups. These authors concluded: “Extended lymphadenectomy does not seem to confer significant overall cancer specific advantage, but does seem to be associated with increased urinary and sexual dysfunction.”

Comments: These findings are in keeping with other studies suggesting that extensive lymphadenectomy does not increase the cure rate of most cancers.

Reference:

[1] Georgiou P, Tan E, Gouvas N, et al. Extended lympadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancer Oncology [early online publication]. September 20, 2009.