Removing the lymph nodes, not just the cancer

This study investigated the effect of lateral pelvic lymph node dissection on survival of rectal cancer patients.

Removal of the lymph nodes in the area surrounding lower rectal cancer (lateral pelvic lymph node dissection or LPND) is often performed during surgery to remove the cancer. LPND is usually performed if imaging scans before surgery indicate a spread of the cancer into these nodes. However, LPND can also be performed as a preventative measure in patients without evidence of cancer in the lymph nodes (referred to as elective LPND). Elective LPND may reduce the rate of recurrence (return of the cancer after treatments) and improve patient survival, and is considered the standard of care in some countries such as Japan.

This study investigated recurrence and 3 year survival rates in 127 patients diagnosed with rectal cancer. All patients were treated with chemotherapy followed by surgery to remove the tumor, with or without LPND. Only 38 patients showed lymph node involvement in imaging scans before surgery and received LPND.

Results showed that overall 5.8% of patients experienced recurrence of the cancer within the first three years after treatment. 7.1% of patients that did not receive LPND experienced cancer recurrence compared to only 2.7% of the patients who underwent LPND. Cancer free survival rates after 3 years were 74.6% in the tumor removal only treatment group, compared to 83.8% of patients in the tumor removal and LPND group.

This study concluded that LPND may be used to reduce recurrence and improve survival, and should be considered also in patients who do not exhibit lymph node involvement in imaging scans before surgery.

Although this study showed a positive trend towards improved survival, this study included only a small number of patients, and results were not necessarily significant after analysis accounting for multiple variables. 

Consult with your physician regarding the risks and benefits of pelvic lymph node dissection.