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Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum

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Abstract

Background and aims

Local recurrence after rectal cancer surgery is conceived to result from microscopically incomplete resection. We aimed to investigate the patterns of mesorectal neoplastic foci, and examined the involvement and micrometastasis of lymph nodes.

Methods

Observation of large tissue slice and analysis of tissue microarray were integrated in the pathological study of 31 total mesorectal excision (TME) specimens.

Results

Altogether, 349 mesorectal neoplastic foci were examined from 18 specimens. Almost 33% of them were in the outer layer of mesorectum. Concerning position of primary tumor, ipsilateral neoplastic foci were significantly more than contralateral neoplastic foci. Distal mesorectal spread was found in four patients with the distance ranging from 1 to 3.5 cm. Four specimens were diagnosed to have circumferential margin involved. Nine hundred seventy-two lymph nodes were harvested with 128 involved by tumor. No significant difference in occurrence of micrometastasis was observed among tumors of different stage.

Conclusions

Combination of large tissue slice and tissue microarray provided a more detailed method in studying the metastasis of rectal cancer. Complete excision of the mesorectum with fascia propria circumferentially intact is essential. Circumferential margin involvement and micrometastasis suggested that tumor spread may go beyond the scope of a single TME procedure.

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References

  1. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following ‘curative’ surgery for large bowel cancer. I. The overall picture. Br J Surg 71:12–16

    CAS  PubMed  Google Scholar 

  2. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    CAS  PubMed  Google Scholar 

  3. Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    CAS  PubMed  Google Scholar 

  4. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    CAS  PubMed  Google Scholar 

  5. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711

    CAS  PubMed  Google Scholar 

  6. Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ (1995) Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 82:1031–1033

    CAS  PubMed  Google Scholar 

  7. de Haas-Kock DF, Baeten CG, Jager JJ, Langendijk JA, Schouten LJ, Volovics A, Arends JW (1996) Prognostic significance of radial margins of clearance in rectal cancer. Br J Surg 83:781–785

    CAS  PubMed  Google Scholar 

  8. Bruch HP, Schwandner O, Schiedeck TH, Roblick UJ (1999) Actual standards and controversies on operative technique and lymph-node dissection in colorectal cancer. Langenbeck’s Arch Surg 384:167–175

    Article  CAS  Google Scholar 

  9. Goudet P, Roy P, Arveux I, Cougard P, Faivre J (1997) Population-based study of the treatment and prognosis of carcinoma of the rectum. Br J Surg 84:1546–1550

    Article  CAS  PubMed  Google Scholar 

  10. Hainsworth PJ, Egan MJ, Cunliffe WJ (1997) Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84:652–656

    Article  CAS  PubMed  Google Scholar 

  11. Topor B, Acland R, Kolodko V, Galandiuk S (2003) Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum 46:779–785

    Article  PubMed  Google Scholar 

  12. Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K (1997) Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg 184:584–588

    CAS  PubMed  Google Scholar 

  13. Shirouzu K, Isomoto H, Kakegawa T (1995) Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 76:388–392

    Google Scholar 

  14. Cawthorn SJ, Parums DV, Gibbs NM, A’Hern RP, Caffarey SM, Broughton CI, Marks CG (1990) Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 335:1055–1059

    CAS  PubMed  Google Scholar 

  15. Hall NR, Finan PJ, al-Jaberi T, Tsang CS, Brown SR, Dixon MF, Quirke P (1998) Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 41:979–983

    CAS  PubMed  Google Scholar 

  16. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334

    Article  CAS  PubMed  Google Scholar 

  17. Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review Committee, Cooperative Clinical Investigators (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357

    PubMed  Google Scholar 

  18. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457

    PubMed  Google Scholar 

  19. Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167

    CAS  PubMed  Google Scholar 

  20. Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900

    CAS  PubMed  Google Scholar 

  21. Goldstein NS, Weldon S, Coffey M, Layfield LJ (1996) Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 106:209–216

    CAS  PubMed  Google Scholar 

  22. Fielding LP, Arsenault PA, Chapuis PH, Dent O, Gathright B, Hardcastle JD, Hermanek P, Jass JR, Newland RC (1991) Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 6:325–344

    CAS  PubMed  Google Scholar 

  23. Gusterson B (1992) Are micrometastases clinically relevant? Br J Hosp Med 47:247–248

    CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by The Key Project of National Outstanding Youth Foundation of China (grant number 39925032).

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Correspondence to Zongguang Zhou.

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Wang, C., Zhou, Z., Wang, Z. et al. Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum. Langenbecks Arch Surg 390, 312–318 (2005). https://doi.org/10.1007/s00423-005-0562-7

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  • DOI: https://doi.org/10.1007/s00423-005-0562-7

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