J.Jpn. Surg. Soc.. 81(7): 676-687, 1980

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Original article

A HISTOLOGICAL STUDY OF LYMPH NODE METASTASIS OBTAINED BY ABDOMINOPELIVIC LYMPH NODES DISSECTION IN RECTAL CANCER

One hundred and ten patients of rectal cancer underwent radical surgery combined with extended dissection of the superior hemorrhoidal, inferior mesenteric and paraaortic lymph nodes (the upward metastasis) together with the lymph nodes along the internal iliac vessels and their branches on the pelvic side wall (the lateral metastasis).
The lymph node metastasis was present in 60 cases (54.5%), where the upward metastasis was present in 58 cases (96.7%) and the lateral metastasis in 19 cases (31.7%).
Concerning to the upward metastasis, the pararectal nodes adjacent to the main growth were positive in 51 cases (87.9%) and the superior hemorrhoidal nodes in 20 cases (34.5%). In only 4 cases (6.9%) the metastasis was present at the root of the inferior mesenteric artery. There was no case harboring the metastasis at the paraaortic node in the present series of the curative operation.
The lateral metastasis had some distinctive features. In 16 cases of the 19 cases with positive lymph nodes the main growth was situated below the peritoneal reflection and in 17 cases there were also accompanying upward metastasis. But in 10 cases of these the concomitant upward metastasis was present only at the pararectal nodes. The main sites of the lateral metastasis were the middle hemorrhoidal nodes (in 6 cases) and the internal iliac nodes (in 5 cases). The lateral metastasis in cases of curative operation tended to be positive in only a single node or nodes of one lymph node group.

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