La linfoadenectomia nel carcinoma colo-rettale [The role of lymphadenectomy in colorectal neoplasms]

Background. The role of lymphadenectomy inthe treatment of large bowel cancer is stili controversiaL,not onLy because it is deemed to bea basic element for a correct postoperative staging,but also because it brings about, accordingto some authors, an enhancement of survivaland of "disease free survival" rates. Thedifficulty to collect case histories with homogeneousdata and the impossibility to identifypreoperatevely with certainty the lymph nodesinvolved, makes it difficult to codify the mostsuitable surgical treatment, even if it is agreedat present, to extend lymph nodes dissectionat least as far as Level II nodes. As a matter offact, despite a slight enhancement of 5-yearsurvival rate (6-8%), a significant increase inmorbility occurs, as reported in the literature,particularly in terms of urological and neurological lesions.However, a few authors, performsystematically Level III dissection, reportinga 20% increase in survival.Methods. Our study, has been carried out on84 patients affected by large bowel neoplasmand admitted to the Institute of Surgicalpathology I of "Vittorio Emanuele" Hospital ofCatania between 1990-1995.Results. This study showed an involvement ofLevel I lymph nodes in 77% of patients and ofLevel n in 33%, while Level III nodes wereaffected only in 4.7% of cases.Conclusions. On the basis of these data and of those reported in the literature, the conclusionis drawn that the most suitable and responsibleattitude is, at present, to perform invariablyLevel I and Level II dissection, reservingthe lymphadenectomy of Level III only toselected cases or when an involvement is documentedpre and intraoperatively.