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Location of Rectal Cancer Within the Circumference of the Rectum Does Not Influence Lymph Node Status

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Abstract

Background

Patients with rectal cancer are treated in multimodal concepts on the basis of their tumor stage. In the context of local excision, it is of major importance to assess the risk of lymph node metastases in patients with T1 or T2 tumors. To identify patients with an increased risk of lymph node metastases, the influence of the location of the tumor within the rectum (anterior, posterior, lateral) and of other variables on lymph node status was investigated.

Methods

All consecutive patients undergoing low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and September 2003 were included. A multivariate analysis was performed focussing on tumor location and other variables as potential predictive factors for lymph node metastases.

Results

Of 148 included patients, 135 (91%) had an anterior and 13 (9%) an abdominoperineal resection. All patients routinely underwent total mesorectal excision. A statistically significant correlation with positive lymph node status was found for patients with lymphatic invasion (P < .0001), higher T stage (P < .0001), presence of distant metastases (M1) (P = .0003), and circular growth of the tumor (P = .003), but not for tumor location. Multivariate analysis confirmed that patients without lymphatic invasion (odds ratio, .1; 95% confidence interval, .02–.48; P = .006) and with a low T stage (odds ratio, .07; 95% confidence interval, .002–.9; P = .004) have a significantly lower risk for positive lymph nodes.

Conclusions

Location of rectal cancer (anterior, posterior, lateral) is not a good predictor for lymph node metastases.

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References

  1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982; 69:613–6

    Article  PubMed  CAS  Google Scholar 

  2. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1(8496):1479–82

    Article  PubMed  CAS  Google Scholar 

  3. Hermanek P, Wiebelt H, Staimmer D, Riedl S. Prognostic factors of rectum carcinoma—experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma. Tumori 1995; 81(3 Suppl):60–4

    CAS  Google Scholar 

  4. Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Rectal Cancer Study Group. Cancer 1990; 66:49–55

    Article  Google Scholar 

  5. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638–46

    Article  PubMed  CAS  Google Scholar 

  6. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40

    Article  PubMed  CAS  Google Scholar 

  7. Glimelius B, Gronberg H, Jarhult J, Wallgren A, Cavallin-Stahl E. A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol 2003; 42:476–92

    Article  PubMed  Google Scholar 

  8. Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61:665–77

    Article  PubMed  Google Scholar 

  9. Chan CL, Bokey EL, Chapuis PH, Renwick AA, Dent OF. Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour. Br J Surg 2006; 93:105–12

    Article  PubMed  CAS  Google Scholar 

  10. Frykholm GJ, Pahlman L, Glimelius B. Combined chemo- and radiotherapy vs radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 2001; 50:427–34

    Article  PubMed  CAS  Google Scholar 

  11. Brown G, Kirkham A, Williams GT, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 2004; 182:431–9

    PubMed  Google Scholar 

  12. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis 2000; 15:9–20

    Article  PubMed  CAS  Google Scholar 

  13. Lee SH, Hernandez de AE, Finne CO, Madoff RD, Garcia-Aguilar J. The effect of circumferential tumor location in clinical outcomes of rectal cancer patients treated with total mesorectal excision. Dis Colon Rectum 2005; 48:2249–57

    Article  PubMed  Google Scholar 

  14. Emslie J, Beart R, Mohiuddin M, Marks G. Use of rectal cancer position as a prognostic indicator. Am Surg 1998; 64:958–61

    PubMed  CAS  Google Scholar 

  15. Topor B, Acland R, Kolodko V, Galandiuk S. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum 2003; 46:779–85

    Article  PubMed  Google Scholar 

  16. Syk E, Torkzad MR, Blomqvist L, Ljungqvist O, Glimelius B. Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer. Br J Surg 2006; 93:113–9

    Article  PubMed  CAS  Google Scholar 

  17. Bleday R, Breen E, Jessup JM, Burgess A, Sentovich SM, Steele G Jr. Prospective evaluation of local excision for small rectal cancers. Dis Colon Rectum 1997; 40:388–92

    Article  PubMed  CAS  Google Scholar 

  18. Blumberg D, Paty PB, Picon AI, et al. Stage I rectal cancer: identification of high-risk patients. J Am Coll Surg 1998; 186:574–9

    Article  PubMed  CAS  Google Scholar 

  19. Brodsky JT, Richard GK, Cohen AM, Minsky BD. Variables correlated with the risk of lymph node metastasis in early rectal cancer. Cancer 1992; 69:322–6

    Article  PubMed  CAS  Google Scholar 

  20. Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology 1995; 108:1657–65

    Article  PubMed  CAS  Google Scholar 

  21. Goldstein NS, Hart J Histologic features associated with lymph node metastasis in stage T1 and superficial T2 rectal adenocarcinomas in abdominoperineal resection specimens. Identifying a subset of patients for whom treatment with adjuvant therapy or completion abdominoperineal resection should be considered after local excision. Am J Clin Pathol 1999; 111:51–8

    PubMed  CAS  Google Scholar 

  22. Tanaka S, Haruma K, Teixeira CR, et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol 1995; 30:710–7

    Article  PubMed  CAS  Google Scholar 

  23. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002; 45:200–6

    Article  PubMed  Google Scholar 

  24. Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 2004; 47:1798–807

    Article  PubMed  Google Scholar 

  25. Buess G, Kipfmuller K, Hack D, Grussner R, Heintz A, Junginger T. Technique of transanal endoscopic microsurgery. Surg Endosc 1988; 2:71–5

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral, and Trauma Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Alexis Ulrich MD, Katrin Himmer MS, Moritz Koch MD, Peter Kienle MD, Markus W. Büchler MD & Jürgen Weitz MD

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  1. Alexis Ulrich MD
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  2. Katrin Himmer MS
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  3. Moritz Koch MD
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  4. Peter Kienle MD
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  5. Markus W. Büchler MD
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  6. Jürgen Weitz MD
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Correspondence to Jürgen Weitz MD.

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Ulrich, A., Himmer, K., Koch, M. et al. Location of Rectal Cancer Within the Circumference of the Rectum Does Not Influence Lymph Node Status. Ann Surg Oncol 14, 2257–2262 (2007). https://doi.org/10.1245/s10434-007-9383-y

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  • DOI: https://doi.org/10.1245/s10434-007-9383-y

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