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Adenocarcinoma of the Lower Third of the Rectum: Metastases in Lymph Nodes Smaller Than 5 mm and Occult Micrometastases; Preliminary Results on Early Tumor Recurrence

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Abstract

Background: The number of examined lymph nodes and metastases in lymph nodes smaller than 5 mm (small lymph nodes) are a determining factor in the stage of rectal cancer although the clinical significance of occult micrometastases is controversial. We are reporting our preliminary results on the identification and prognostic utility of metastases in small lymph nodes and occult micrometastases.

Methods: We searched small metastatic lymph nodes in 101 cases of adenocarcinoma of the lower third of the rectum. We used the manual technique to dissect mesorectal fat and occult micrometastases in the lymph nodes of 52 Dukes’ A and B patients, using a pool of anticytokeratin antibodies.

Results: Forty-five percent of the metastatic lymph nodes were smaller than 5 mm in diameter and determined the Dukes’ stage in 15 (30.6%) of 49 Dukes’ C patients. Occult micrometastases were found in 21 (40.4%) patients: five recurred but vascular invasion, positive distal margin of the rectum, and positive circumferential margin of the mesorectum were present.

Conclusions: Small metastatic lymph nodes, vascular invasion, positive distal margin of the rectum, and positive circumferential margin of the mesorectum were found to be more important than occult micrometastases in predicting early recurrence of rectal cancer.

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Authors and Affiliations

  1. Department of Anatomical Pathology and Cytology and Division of Surgical Oncology B, National Cancer Institute, Milan, Italy

    Salvatore Andreola MD, Grazia Sirizzotti & Giuseppe Sampietro PhD

  2. Division of Surgical Oncology B, National Cancer Institute, Milan, Italy

    Ermanno Leo MD, Filiberto Belli MD & Gianfrancesco Gallino MD

  3. Department of Anatomical Pathology and Cytology, National Cancer Institute, Via G. Venezian 1, 20133, Milano, Italy

    Salvatore Andreola MD

Authors
  1. Salvatore Andreola MD
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  2. Ermanno Leo MD
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  3. Filiberto Belli MD
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  4. Gianfrancesco Gallino MD
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  5. Grazia Sirizzotti
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  6. Giuseppe Sampietro PhD
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Andreola, S., Leo, E., Belli, F. et al. Adenocarcinoma of the Lower Third of the Rectum: Metastases in Lymph Nodes Smaller Than 5 mm and Occult Micrometastases; Preliminary Results on Early Tumor Recurrence. Ann Surg Oncol 8, 413–417 (2001). https://doi.org/10.1007/s10434-001-0413-x

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  • DOI: https://doi.org/10.1007/s10434-001-0413-x

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