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Distribution of lymph nodes in the mesorectum: how deep is TME necessary?

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Abstract

Background

Standardization of total mesorectal excision (TME) had a great impact on decreasing local recurrence rates for the treatment of rectal cancer. However, exact numbers and distribution of lymph nodes (LN) along the mesorectum remains controversial with some studies suggesting that few LNs are present in the distal third of the mesorectum.

Methods

Eighteen fresh cadavers without a history of rectal cancer were studied. The rectum was removed by TME and then was divided into right lateral, posterior and left lateral sides, which were further subdivided into 3 levels (upper, middle and lower). A pathologist determined the number and sizes of the LNs in each of the nine areas, b linded to their anatomical origin.

Results

Overall, the mesorectum had a mean of 5.7 LNs (SD=3.7) and on average each LN had a maximum diameter of 3.0 mm (SD=2.7). There was no association between the mean number or size of LNs with gender, BMI, or age. There was a significantly higher prevalence of LNs in the posterior location (2.8 per mesorectum) than in the two lateral locations (0.8 and 1.2 per mesorectum; p=0.02). The distribution of LNs in the three levels of the rectum was not significant.

Conclusions

The distribution of LNs reinforces the fact that TME should always include the distal third of the mesorectum. Care must be taken to not violate the posterior aspect of the mesorectum.

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Authors and Affiliations

  1. Department of Gastroenterology School of Medicine, University of São Paulo, São Paulo, Brazil

    R. O. Perez, V. E. Seid, C. Bresciani, I. Proscurshim, D. D. Pereira, D. Kruglensky, A. Habr-Gama & D. Kiss

  2. School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil

    E. H. Bresciani

  3. Department of Pathology School of Medicine, University of São Paulo, São Paulo, Brazil

    V. Rawet

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  1. R. O. Perez
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  2. V. E. Seid
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  3. E. H. Bresciani
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  4. C. Bresciani
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  5. I. Proscurshim
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  6. D. D. Pereira
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  7. D. Kruglensky
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  8. V. Rawet
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  9. A. Habr-Gama
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  10. D. Kiss
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Correspondence to R. O. Perez.

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Perez, R.O., Seid, V.E., Bresciani, E.H. et al. Distribution of lymph nodes in the mesorectum: how deep is TME necessary?. Tech Coloproctol 12, 39–43 (2008). https://doi.org/10.1007/s10151-008-0396-8

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  • DOI: https://doi.org/10.1007/s10151-008-0396-8

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