Introduction In the radical surgery of the neoplasm of the rectum the need to limit the local spread of the tumor aimed at reducing relapses is now accepted the tendency to widen the surgical indications that include the resection of the pelvic lymphatic cell structures potentially responsible for the risk of recurrence, with a resumption of the disease. (1.2.3.4.5) The objective of the present study is to evaluate the lymphectomy under peritoneal conduct in RAs to find indicators that can reduce the risk of relapses and modify surgical tactics. Materials and methods From January 2010 to December 2017 consult the database of the AOU "G Rodolico" University of Catania Department of surgical and specialist medical sciences II were treated 16 patients with adenocarcinoma with seat, in sigma-rectum (high) n 6 cases (6.2%), and in the rectum (low) 10 cases (T2b). The clinical signs showed that the clinical examination was present: blood in the stool accompanied by diarrhea, constipation, asthenia, malaise, rapid weight loss and anemia without apparent reasons the surgical treatment implemented in the group of patients examined showed the need for curative intervention with the removal of the middle rectum and the execution of an ultra-low anastomosis. Results: The interventions for colic tumor the conservation of the sphincters was implemented in all the treated patients. The postoperative exitus occurred in only n 2 cases (15%), in patients with advanced age (over 80). The anastomosis dehiscence was also present in 2 cases (15%) and the postoperative fistulae in 1 case (7.5%) in this group of patients the presence of local recurrence was 30% (5 cases). the total lymph node counts in patients with local recurrence showed a high rate of tumor positivity, with a total number of lymph nodes removed less than 10, therefore considered to be high risk patients and sent to adjuvant treatment. Discussion Despite the changes in technique adopted, both anastomosis dehiscences (15%) and postoperative fistulas (7.5%) occurred, but not bladder and sexual complications as the dissection of the middle rectum was to conduct along the holy plane. The resections of the middle rectum allowed a more comfortable pelvic lymphectomy as confirmed by other AAs (49,50,51,52,53) the radicality was sought to obtain a more favorable survival rate in the presence of interventions with regional lymphectomy. (54,55,56,57) The invasion of the lymph nodes concerned the lateral lymph nodes (common ileac, external hypogastric iliac). Conclusions were confined the search for an increasingly radical surgery in the ac of the rectum is aimed at reducing the local diffusion of the tumor and the incidence of pelvic recurrences. The choice of the type of conservative or demolition intervention does not reveal statistical differences in the two treatments is the pelvic lymphectomy with the removal of the lymphatic cell structures with tumor sterilization performed with chemo or adjuvant radiotherapy that raises the survival index and reduces the onset of local recurrences also in our experience.
