[Lymphadenectomy with tumors of the lower gastrointestinal tract]

For advanced adenocarcinomas, which are the most frequent tumours of the lower GI tract, the concept of radical lymphnode dissection is well accepted. The quality of lymphadenectomy for these malignancies has a strong effect on cancer-related survival. Based upon a strict quality control program with outcome evaluated according to internal results, the technique and extent of lymph node dissection have been continuously developed over the last three decades. These are described in detail, including instructive pictures to clarify the surgical steps needed. Apart from multivisceral resection in far advanced cases, which still have a chance of cure if adequate guidelines are followed, two additional steps in the so-called radical surgical treatment of these tumours are prerequisites for cure. The first is complete mobilisation of the intestine involving complete mesocolic excision with complete retention of the visceral fascia and covering potential lymph node metastases and extranodal spread on the intestinal side. The second step is the central tying of the tumor's supplying vessels. Following these rules and with no adjuvant systemic treatment, 5-year survival figures of 80% can be reached, even for UICC stage III disease.