Objective To study the rule of lymphatic metastasis and to evaluate the extent of curative resection in advanced colorectal cancer.
Methods One thousand and five lymph nodes from 114 consecutive patients with colorectal cancer underwent extended D3 resection were analyzed and classified as peritumor, longitudinal, and upward spread distribution. Results The metastatic rate and incidence of lymph node metastasis in peritumor, longitudinal as well as upward spread (N2 and N3) was 43.9% and 37.2%, 32.5% and 15.9% as well as 29.8% (19.3% and 10.5%) and 12.1% (16.6% and 7.8%) respectively. The distribution rate of metastatic lymph nodes was 17.5% and 23.5% in the longitudinal and upward spread respectively. In the longitudinal spread, most of lymph node metastasis was seen within 10 cm. Within 2 cm on the anal side in rectal cancer, the metastasis rate was 5.5%, and there was no metastasis in 2-4 cm. The lateral metastasis rate was 0%, 8.7% and 12.5% in the rectosigmoid (Rs), upper rectum (Ra) and lower rectum (Rb) respectively.
Conclusion Advanced colorectal cancer tend to metastasize to longitudinal and upward lymph nodes. Jump metastasis is also a feature. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis. Extended D3 radical resection is necessary for colic cancer, but high ligation of the inferior mesenteric artery root as well as lateral lymphadenectomy and total mesenteric excision should also be performed for rectal cancer. There is no residual tumor tissue in the anastomosis when the excision distance is beyond 2 cm from the anal margin in rectal cancer.
Citation：
GAO Youfu,JIANG Bojian,SUN Rongxun,et al.. CLINICAL STUDIES ON THE RULE OF LYMPHATIC METASTASIS FOR ADVANCED COLORECTAL CANCER. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2000, 7(1): 27-29. doi:
Copy
Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. |
Japanese Research Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus 〔M〕. 5th ed. Tokyo: Kanehara, 1994∶14-25.
|
| 2. |
Sobin LH, Wittekind CH, eds. UICC TNM classification of malignant tumors 〔M〕. 5th ed. New York: Wile Liss, 1997∶66-69.
|
| 3. |
Tagliacozzo S, Tocchi A. Extended mesenteric excision in right hemicolectomy for carcinoma of the colon 〔Ｊ〕. Inter J Colorectal Dis, 1997; 12(5)∶272.
|
| 4. |
Hida J, Yasutomi M, Fujimoto K, et al. Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastasis by the clearing method 〔Ｊ〕. Am Coll Surg, 1997; 184(5)∶475.
|
| 5. |
Hida J, Yasutomi M, Maruyama T, et al. Lymph node metastasis detected in the mesorectum distal to carcinoma of the rectum by the clearing method: Justification of total mesorectal excision 〔Ｊ〕. Am Coll Surg, 1997; 184(6)∶584.
|
| 6. |
Morikawa E, Yasutomi M, Shindou K, et al. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method 〔Ｊ〕. Dis Colo Rect, 1994; 37(3)∶219.
|
| 7. |
Hida J, Yasutomi M, Maruyama T, et al. Indication for using high ligation of the inferior mesenteric artery in rectal cancer surgery: examination of nodal metastasis by the clearing method 〔Ｊ〕. Dis Colo Rect, 1998; 41(8)∶984.
|
| 8. |
Williams NS. The rational for preservation of the anal sphincter in patients with low rectal cancer 〔Ｊ〕. Br J Surg, 1984; 7(14)∶575.
|
| 9. |
Takashima S, Sekino H, Kiriyama M, et al. A study on the lymphatic metastatic pattern of the colonic cancer 〔Ｊ〕. JPN J Gastroenterol Surg, 1984; 17(10)∶763.
|
| 10. |
Sott N, Jackson P, AlJaberi T, et al. Total mesorectal excisioin and local recurrence: a study of tumor spread in the mesorectum distal to rectal cancer 〔Ｊ〕. Br J Surg, 1995; 82(7)∶1031.
|
| 11. |
Moriya Y, Sugihara K, Akasu T, et al. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer 〔Ｊ〕. World J Surg, 1997; 21(7)∶728.
|
- 1. Japanese Research Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus 〔M〕. 5th ed. Tokyo: Kanehara, 1994∶14-25.
- 2. Sobin LH, Wittekind CH, eds. UICC TNM classification of malignant tumors 〔M〕. 5th ed. New York: Wile Liss, 1997∶66-69.
- 3. Tagliacozzo S, Tocchi A. Extended mesenteric excision in right hemicolectomy for carcinoma of the colon 〔Ｊ〕. Inter J Colorectal Dis, 1997; 12(5)∶272.
- 4. Hida J, Yasutomi M, Fujimoto K, et al. Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastasis by the clearing method 〔Ｊ〕. Am Coll Surg, 1997; 184(5)∶475.
- 5. Hida J, Yasutomi M, Maruyama T, et al. Lymph node metastasis detected in the mesorectum distal to carcinoma of the rectum by the clearing method: Justification of total mesorectal excision 〔Ｊ〕. Am Coll Surg, 1997; 184(6)∶584.
- 6. Morikawa E, Yasutomi M, Shindou K, et al. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method 〔Ｊ〕. Dis Colo Rect, 1994; 37(3)∶219.
- 7. Hida J, Yasutomi M, Maruyama T, et al. Indication for using high ligation of the inferior mesenteric artery in rectal cancer surgery: examination of nodal metastasis by the clearing method 〔Ｊ〕. Dis Colo Rect, 1998; 41(8)∶984.
- 8. Williams NS. The rational for preservation of the anal sphincter in patients with low rectal cancer 〔Ｊ〕. Br J Surg, 1984; 7(14)∶575.
- 9. Takashima S, Sekino H, Kiriyama M, et al. A study on the lymphatic metastatic pattern of the colonic cancer 〔Ｊ〕. JPN J Gastroenterol Surg, 1984; 17(10)∶763.
- 10. Sott N, Jackson P, AlJaberi T, et al. Total mesorectal excisioin and local recurrence: a study of tumor spread in the mesorectum distal to rectal cancer 〔Ｊ〕. Br J Surg, 1995; 82(7)∶1031.
- 11. Moriya Y, Sugihara K, Akasu T, et al. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer 〔Ｊ〕. World J Surg, 1997; 21(7)∶728.
