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The Lymphatic Spread of the Rectal Cancer

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Surgical Treatment of Colorectal Cancer

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Abstract

The lymph spread of the rectal cancer is various according to the tumor location. Pathways of lymphatic drainage are dived into three groups, the upper two thirds of the rectum, dentate line up to the lower third of the rectum, and the anal canal up to dentate line. Lymph node metastasis from rectal cancer usually occurs in regional rectal lymph nodes that consist of three groups: perirectal, intermediate and main lymph nodes, and lateral pelvic lymph nodes. The concept of total mesorectal excision is equally accepted in the West and East, but the role of lateral pelvic lymph node dissection is accepted differently. Therefore, recently selective pelvic lymph node dissection after preoperative chemoradiotherapy was proposed. Moreover, whole-mount sections or fat clearance techniques have been performed for the precise pathologic assessment after surgery. The lymph node metastasis of rectal cancer progresses differently under various conditions, so the management of rectal cancer should consider various aspects through multidisciplinary team approach.

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References

  1. Dujovny N, Quiros RM, Saclarides TJ. Anorectal anatomy and embryology. Surg Oncol Clin N Am. 2014;13:277–93.

    Article  Google Scholar 

  2. Bell S, Sasaki J, Sinclair G, Chapuis PH, Bokey EL. Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues. Color Dis. 2009;11:443–9.

    Article  CAS  Google Scholar 

  3. Blair JB, Holyoke A. A note on the lymphatics of the middle and lower rectum and anus. Anat Rec. 1950;108:635–43.

    Article  CAS  Google Scholar 

  4. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    Article  CAS  Google Scholar 

  5. Nakamura T, Watanabe M. Lateral lymph node dissection for lower rectal cancer. World J Surg. 2013;37:1808–13.

    Article  CAS  Google Scholar 

  6. Montori A, Miscusi G, Saracca L, et al. Transrectal sonography and endoscopic lymphoscintigraphy in the preoperative staging of rectal cancer. Dig Surg. 1984;1:200–4.

    Article  Google Scholar 

  7. Arnaud JP, Bergamaschi R, Schloegel M, Ollier JC, Haegele P, Grob JC, Adloff M. Progress in the assessment of lymphatic spread in rectal cancer. Rectal endoscopic lymphoscintigraphy. Dis Colon Rectum. 1990;33:398–401.

    Article  CAS  Google Scholar 

  8. Grinnell RS. The lymphatic and venous spread of carcinoma of rectum. Ann Surg. 1942;116:200–16.

    Article  CAS  Google Scholar 

  9. Hida J, Yasutomi M, Maruyama T. 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. 1997;184:584–8.

    CAS  PubMed  Google Scholar 

  10. Williams 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. Br J Surg. 1987;70:150–4.

    Article  Google Scholar 

  11. Yao Y-F, Wang L, Liu Y-Q, Li J-Y, Gu J. Lympn node distribution and pattern of metastases in the mesorectum following total mesorectal excision using the modified fat clearing technique. J Clin Pathol. 2011; 64:1073–7.

    Article  Google Scholar 

  12. Cserni G, Tarjan M, Bori R. Distance of lymph nodes from the tumor, an important feature in colorectal cancer specimens. Arch Pathol Lab Med. 2001;125:246–9.

    CAS  PubMed  Google Scholar 

  13. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma, 2nd ed. (English). Tokyo: Kanehara; 2009.

    Google Scholar 

  14. Korean Clinical Practice Guideline for Colon and Rectal Cancer v.1.0. Ivy Plan, Korean Medical Association, Seoul; 2012.

    Google Scholar 

  15. Ishihara S, Kawai K, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Morikawa T, Watanabe T. Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy. Dis Colon Rectum. 2017;60:469–76.

    Article  Google Scholar 

  16. Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 2014;21:189–96.

    Article  Google Scholar 

  17. Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbeck’s Arch Surg. 1998;383:409–15.

    Article  CAS  Google Scholar 

  18. Moriya Y, Sugihara K, Akasu T, Fujita S. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg. 1997;21:728–32.

    Article  CAS  Google Scholar 

  19. Ueno M, Oya M, Azekuru K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.

    Article  CAS  Google Scholar 

  20. Kusters M, Beets GL, van de Velde CJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;10:1053–62.

    Google Scholar 

  21. Sauer I, Bacon HE. A new approach of excision of carcinoma of the lower portion of the rectum and anal canal. Surg Gynecol Obstet. 1952;95:229–42.

    CAS  PubMed  Google Scholar 

  22. Takahashi T, Ueno M, Azekura K, Ota H. The lymphatic spread of rectal cancer and the effect of dissection: Japanese contribution and experience. In: des Soreide O, Norstein J, editors. Rectal Cancer surgery. Optimisation standardisation documentation. Berlin: Springer-Verlag; 1997. p. 165–80.

    Google Scholar 

  23. Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10:1053–62.

    Article  Google Scholar 

  24. Fujita S, Akasu T, Mizusawa J, Saito N, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomized controlled, non-inferiority trial. Lancet Oncol. 2012;13:616–21.

    Article  Google Scholar 

  25. Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, et al. Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol. 2016;42:1851–8.

    Article  CAS  Google Scholar 

  26. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, et al. Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg. 2017;266:201–7.

    Article  Google Scholar 

  27. Kim TH, Jeong SY, CHoi DH, et al. Lateral lymph node metastasis is a mjor cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008;15:729–37.

    Article  Google Scholar 

  28. Oh HK, Kang SB, Lee SM, Lee SY, Ihn MH, Kim DW, Park JH, Kim YH, Lee KH, Kim JS, Kim JW, Kim JH, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ. Neoadjuvant chemoradiotherapy affects the indications for lateral pelvic node dissection in mid/low rectal cancer with clinically suspected lateral node involvement: a multicenter retrospective cohort study. Ann Surg Oncol. 2014;21:2280–7.

    Article  Google Scholar 

  29. Kim MJ, Kim TH, Kim DY, Kim SY, Baek JY, Chang HJ, Park SC, Park JW, Oh JH. Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol. 2015;111:459–64.

    Article  Google Scholar 

  30. Kwon TS, Choi SB, Lee YS, Kim J-G, Oh ST, Lee IK. Novel methods of lymph node evaluation for predicting the prognosis of colorectal cancer patients with inadequate lymph node harvest. Cancer Res Treat. 2016;48:216–24.

    Article  Google Scholar 

  31. Herrera-Ornelas L, Justiniano J, Castillo N, et al. Metastases in small lymph nodes from colon cancer. Arch Surg. 1987;122:1253–6.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

    In Kyu Lee

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  1. In Kyu Lee
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Correspondence to In Kyu Lee .

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Editors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Nam Kyu Kim

  2. Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

  3. Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan

    Jin-Tung Liang

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Lee, I.K. (2018). The Lymphatic Spread of the Rectal Cancer. In: Kim, N., Sugihara, K., Liang, JT. (eds) Surgical Treatment of Colorectal Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-5143-2_5

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  • DOI: https://doi.org/10.1007/978-981-10-5143-2_5

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  • Publisher Name: Springer, Singapore

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  • Online ISBN: 978-981-10-5143-2

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