Abstract
Sixty-three patients with mobile rectal cancer were examined preoperatively with endorectal ultrasonography (EUS). The depth of infiltration and the presence of mesorectal lymph node metastases could be assessed in 53 patients. Doppler ultrasonography was performed in 16 cases with suspected lymph node enlargement in order to discriminate between lymph nodes and blood vessels. Tumour growth in the bowel wall was correctly estimated in 43 (81%) patients. The degree of spread was overestimated in five patients and underestimated in five. The evaluation of the mesorectal lymph node status was also accurate in 43 (81%) patients. Nine patients had one or several regional lymph node metastases, but the EUS revealed only some of the metastatic lymph nodes in each case. In the other 34, no lymph node metastases were found. In two patients the EUS was falsely positive since no lymph nodes could be demonstrated in the operative specimens. In eight patients the examination was falsely negative. EUS is considered to be an accurate method for preoperative assessment of tumour infiltration in the bowel wall as the risk of understaging was under 10%. Preoperative irradiation and surgery may be chosen based on the EUS-determined tumour extension into the rectal wall.
Résumé
63 malades avec un cancer du rectum mobile ont été examinés préopératoirement par ultrasonographie endorectale (USE). La profondeur de l'infiltration et la présence de métastases ganglionnaires dans le mésorectum ont pu être évalués chez 53 malades. Un doppler par ultrasonographie a été effectué dans 16 cas avec une hypertrophie suspecte des ganglions lymphatiques afin de distinguer entre les ganglions et les vaisseaux sanguins. La pénétration tumorale dans la paroi intestinale, a été correctement estimée chez 43 malades (81%). Le degré d'extension a été surestimé chez 5 malades et sousestimé chez 5 autres. L'évaluation de l'état des ganglions lymphatiques du mésorectum était aussi correcte chez 43 malades (81%). 9 malades avaient une ou plusieurs métastases des ganglions régionaux, mais l'ultrasonographie ne révélait que quelques uns des ganglions métastatiques dans chaque cas. Chez les 34 autres patients aucume métastase ganglionnaire n'a été trouvée. Chez 2 malades l'USE était faussement positive puisque aucun ganglion n'a pu être démontré sur la pièce opératoire. Chez 8 malades, l'examen était faussement négatif. L'ultrasonographie endorectale est considérée comme étant une méthode sûre pour l'appréciation pré-opératoire de l'infiltration tumorale dans l'intestin puisque le risque de sousestimation est au dessous de 10%. L'irradiation pré-opératoire et la chirurgie peuvent être choisies sur la base de l'extension tumorale dans la paroi rectale déterminée par l'ultrasonographie endorectale.
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Lindmark, G., Elvin, A., Påhlman, L. et al. The value of endosonography in preoperative staging of rectal cancer. Int J Colorect Dis 7, 162–166 (1992). https://doi.org/10.1007/BF00360359
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DOI: https://doi.org/10.1007/BF00360359