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Erschienen in: Langenbeck's Archives of Surgery 4/2005

01.08.2005 | Original Article

Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum

verfasst von: Cun Wang, Zongguang Zhou, Zhao Wang, Yangchun Zheng, Gaoping Zhao, Yongyang Yu, Zhong Cheng, Daiyun Chen, Weiping Liu

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2005

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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.
Literatur
1.
Zurück zum Zitat 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 71:12–16PubMed 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 71:12–16PubMed
2.
Zurück zum Zitat Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616PubMed Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616PubMed
3.
Zurück zum Zitat 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 2:996–999PubMed 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 2:996–999PubMed
4.
Zurück zum Zitat Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMed Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMed
5.
Zurück zum Zitat 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 344:707–711PubMed 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 344:707–711PubMed
6.
Zurück zum Zitat 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 82:1031–1033PubMed 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 82:1031–1033PubMed
7.
Zurück zum Zitat 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 83:781–785PubMed 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 83:781–785PubMed
8.
Zurück zum Zitat 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 384:167–175CrossRef 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 384:167–175CrossRef
9.
Zurück zum Zitat 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 84:1546–1550CrossRefPubMed 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 84:1546–1550CrossRefPubMed
10.
Zurück zum Zitat Hainsworth PJ, Egan MJ, Cunliffe WJ (1997) Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84:652–656CrossRefPubMed Hainsworth PJ, Egan MJ, Cunliffe WJ (1997) Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84:652–656CrossRefPubMed
11.
Zurück zum Zitat Topor B, Acland R, Kolodko V, Galandiuk S (2003) Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum 46:779–785CrossRefPubMed Topor B, Acland R, Kolodko V, Galandiuk S (2003) Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum 46:779–785CrossRefPubMed
12.
Zurück zum Zitat 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 184:584–588PubMed 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 184:584–588PubMed
13.
Zurück zum Zitat 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 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
14.
Zurück zum Zitat 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 335:1055–1059PubMed 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 335:1055–1059PubMed
15.
Zurück zum Zitat 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 41:979–983PubMed 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 41:979–983PubMed
16.
Zurück zum Zitat 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 89:327–334CrossRefPubMed 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 89:327–334CrossRefPubMed
17.
Zurück zum Zitat 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 26:350–357PubMed 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 26:350–357PubMed
18.
Zurück zum Zitat 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 235:449–457PubMed 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 235:449–457PubMed
19.
Zurück zum Zitat Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167PubMed Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167PubMed
20.
Zurück zum Zitat Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMed Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMed
21.
Zurück zum Zitat 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 106:209–216PubMed 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 106:209–216PubMed
22.
Zurück zum Zitat 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 6:325–344PubMed 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 6:325–344PubMed
23.
Zurück zum Zitat Gusterson B (1992) Are micrometastases clinically relevant? Br J Hosp Med 47:247–248PubMed Gusterson B (1992) Are micrometastases clinically relevant? Br J Hosp Med 47:247–248PubMed
Metadaten
Titel
Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum
verfasst von
Cun Wang
Zongguang Zhou
Zhao Wang
Yangchun Zheng
Gaoping Zhao
Yongyang Yu
Zhong Cheng
Daiyun Chen
Weiping Liu
Publikationsdatum
01.08.2005
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 4/2005
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-005-0562-7

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