Abstract
PURPOSE: The aim of this study was to clarify the distribution of lymph node metastasis in colorectal cancer. We also examined the relationship between the primary tumor (T) and the regional node (N) categories of the TNM (primary tumor, regional nodes, metastasis) classification. METHOD: Lymph nodes of surgical specimens in 311 consecutive patients with colorectal cancer were studied using the modified clearing method. RESULTS: Lymph node metastasis was seen in 59.2 percent of the total cases. The upward metastasis rate was 30.7 percent. In the longitudinal spread, most of the lymph node metastasis was seen within 10 cm. On the oral side in rectal cancer, there was no metastasis beyond 4 cm. The lateral metastasis rate in rectal cancer was 8.8 percent and in the lower rectum, the rate of cancer within 6 cm from the anal verge or beyond pT3 was much higher. CONCLUSION: In the TNM classification, there was no significant difference between colon and rectal cancer except pT1 with rectal cancer. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis, and lateral lymph node dissection or radiation therapy should be performed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Scott KW, Grace RH. Detection of lymph node metastasis in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165–7.
Izumoto G. Studies on the lymph node metastasis of the colorectal cancer by the modified clearing method. Med J Kinki Univ 1984;9:239–53.
Cawthorn SJ, Gibbs NM, Marks CG. Clearance technique for the detection of lymph nodes in colorectal cancer. Br J Surg 1986;73:58–60.
Herrera-Ornelas L, Justiniano J, Castillo N, Petrelli NJ, Stulc JP, Mittelman A. Metastasis in small lymph nodes from colon cancer. Arch Surg 1987;122: 1253–6.
Gilchrist RK, David VC. Lymphatic spread of carcinoma of the rectum. Ann Surg 1938;108:621–42.
Hatta M. Effects of lymphatic vessel invasion and stromal response on lymphnode metastasis of colorectal cancer: by clearing method. Med J Kinki Univ 1987;12:483–99.
Iwasa Z, Fukuhara T, Yasutomi M,et al. Modified clearing method for examination of regional lymph nodes in breast cancer. Med J Kinki Univ 1978;3: 1–6.
Harmanek P. The new TNM/pTNM classification of colorectal carcinoma: what has changed and why? Coloproctology 1988;1:6–12.
Morson BC. Precancerous and early malignant lesions of the large intestine. Br J Surg 1968;55: 725–31.
Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982;144:350–4.
Grinnel RS. Lymphatic block with atypical and retrograde lymphatic metastasis and spread on carcinoma of the colon and rectum. Ann Surg 1966;163: 272–80.
Takashima S, Sekino H, Kiriyama M,et al. A study on the lymphatic metastatic pattern of the colonic cancer. Jpn J Gastroenterol Surg 1984;17:763–70.
Grinnel RS. The lymphatic and venous spread of carcinoma of the rectum. Ann Surg 1942;116: 200–16.
Suda T, Hatakeyama H, Okamoto H,et al. Intramural spread of carcinoma of the rectum—a histological study of proposed distal margin of resection. J Jpn Soc Coloproctol 1992;45:421–6.
Enker WE, Heilweil ML, Hertz RL,et al. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer. Ann Surg 1986;203:426–33.
Stearns MW Jr, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 1959;2: 169–72.
Author information
Authors and Affiliations
Additional information
Supported in part by a Grant-in-Aid For Cancer Research from the Ministry of Health and Welfare, and Scientific Research from the Ministry of Education, Culture and Science (c-60570630), the government of Japan.
Read in part at the meeting of The Japan Society for Cancer Therapy, Tokyo, Japan, September 16 to 19, 1992.
About this article
Cite this article
Morikawa, E., Yasutomi, M., Shindou, K. et al. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum 37, 219–223 (1994). https://doi.org/10.1007/BF02048158
Issue Date:
DOI: https://doi.org/10.1007/BF02048158