Morbidity and mortality of wide pelvic lymphadenectomy for rectal adenocarcinoma

This retrospective study was aimed at defining the morbidity and mortality of a radical resection for adenocarcinoma of the rectum complemented by a wide pelvic lymphadenectomy. Twenty-seven consecutive patients with rectal carcinoma who underwent a surgical resection with conventional (Group I) or wide (Group II) pelvic lymphadenectomy were analyzed. Group I consisted of 10 patients (three women and seven men; mean age, 71 years) with tumors between 6 and 14 cm (mean, 10.6 cm) from the anal verge. Group II consisted of 17 patients (eight women and nine men; mean age, 67 years) with tumors between 3 and 14 cm (mean, 9 cm) from the anal verge. The choice of lymphadenectomy in association with colorectal resection was left at the discretion of the surgeon. There were no deaths within 60 days of operation. Mean intraoperative blood loss was the same in the two groups, although three patients (18 percent) required blood transfusions of over two liters during the performance of a wide pelvic lymphadenectomy in comparison with only one (10 percent) during conventional pelvic lymphadenectomy. The rate of early postoperative complications and the average length of postoperative hospital study were each similar between the two groups. After a wide pelvic lymphadenectomy, three (18 percent) patients developed a neurogenic bladder, requiring intermittent self-catheterization, and they all recovered within one, four, and eight months, respectively. Of the 16 males, three from Group I and four from Group II were sexually active and potent before surgical treatment; after recovering from surgery, only two patients from Group I regained their sexual potency. We conclude that the performance of a wide pelvic lymphadenectomy did not increase the intraoperative or early postoperative complication rate, the mean intraoperative blood loss, or the length of postoperative hospital stay. Technical refinements are currently under study to obviate the neurologic long-term complications.