Scientific paper
Lymphatic spread and its prognostic value in patients with rectal cancer

https://doi.org/10.1016/0002-9610(82)90018-6Get rights and content

Abstract

The incidence of lymph node metastasis in 423 patients with resected rectal cancer was 51.4 percent. There was no correlation between the size of the tumor and metastasis when the maximum diameter of the tumor exceeded 3 cm, and metastasis was seen in more than 50 percent of the patients. Metastasis was seen in 17.9 percent of the patients with cancer limited to the mucosa (mucosal and submucosal layer), in 37.8 of those with penetration limited to the propria muscle, and in more than 50 percent of those with penetration to the serosa or invasion into other organs. With lower rectal cancer, lateral metastasis was seen in 23 percent of the patients with advanced cancer, and inguinal lymph node metastasis in 6 percent. The 5 year survival rate of Dukes' C patients was as low as 33 percent, but was 52.9 percent in the patients with metastasis to only the pararectal lymph node; the prognosis of lateral metastasis is poor. As a subclassification of Dukes' C, levels 1, 2, 3, 4, and 5 are proposed on the basis of the extent of lymphatic spread.

References (29)

  • JP Welch et al.

    Recent experience in the management of cancer of the colon and rectum

    Am J Surg

    (1974)
  • RS Grinnel

    The spread of carcinoma of the colon and rectum

    Cancer

    (1950)
  • VB Astler et al.

    The prognostic significance of direct extension of carcinoma of the colon and rectum

    Ann Surg

    (1954)
  • MW Stearns et al.

    Five year results of abdominopelvic lymph node dissection for carcinoma of the rectum

    Dis Colon Rectum

    (1959)
  • JM Shepherd et al.

    Adenocarcinoma of the large bowel

    Br J Cancer

    (1971)
  • KW Falterman et al.

    Cancer of the colon rectum and anus

    Cancer

    (1974)
  • P Rubin

    Current concepts in cancer

    JAMA

    (1975)
  • AR Grapp et al.

    Accuracy of lymph node assessment in carcinoma of the rectum

  • M Whittaker et al.

    The prognosis after surgical treatment for carcinoma of the rectum

    Br J Surg

    (1976)
  • SK Cater

    Large bowel cancer: the current status of treatment

    J Natl Cancer Inst

    (1976)
  • RS Grinnel

    Lymphatic metastases of carcinoma of the colon and rectum

    Ann Surg

    (1950)
  • RK Gilchrist

    Fundamental factors governing lymphatic spread of carcinoma

    Ann Surg

    (1948)
  • FA Coller et al.

    Regional lymphatic metastases of carcinoma of the rectum

    Surgery

    (1940)
  • CF Dixon

    Anterior resection for malignant lesion of the upper part of the rectum and lower part of the sigmoid

    Ann Surg

    (1948)
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    This work was supported in part by a Grant-in Aid (55-1) for Cancer Research from the Ministry of Health and Welfare, Tokyo, Japan.

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