Study on Distal Intramural Spread of Rectal Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Wenjun ¹ , ZHANG Caiquan ² , WANG Qing. ³

Department of General Surgery, Taizhou Hospital of Zhejiang Province, Linhai 317000, China;

Corresponding author：

Keywords：

Rectal neoplasm Distal intramural spread Operation

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【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery.
MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination.
ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage.
Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.

Citation： ZHAO Wenjun,ZHANG Caiquan,WANG Qing.. Study on Distal Intramural Spread of Rectal Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(1): 94-96下转105. doi: Copy

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1. Hida J, Mori N, Kubo R, et al. Metastases from carcinoma of the colon and rectum detected in small lymph nodes by the clearing method [Ｊ]. J Am Coll Surg, 1994; 178(3)∶2232Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival [Ｊ]. Br J Surg, 1983; 70(3)∶150.
2. Kwok SP, Lau WY, Leung KL, et al. Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma [Ｊ]. Br J Surg, 1996; 83(7)∶969.
3. Kazuo S, Isomoto H. Distal spread of rectal and optional distal margin of resection for sphincterpreserving surgery [Ｊ]. Cancer, 1995; 76(3)∶388.
4. 刘晖，万德森，吴秋良，等. 大切片上直肠癌远端壁内扩散的研究 [Ｊ]. 中华肿瘤杂志， 2001； 23（1）∶50.
5. 邓海军，卿三华，李国新. 直肠癌安全远端切缘的研究进展 [Ｊ]. 中国胃肠外科杂志， 1999； 2（3）∶190.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on Distal Intramural Spread of Rectal Carcinoma

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