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Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 15, 2004; 10(22): 3369-3373
Published online Nov 15, 2004. doi: 10.3748/wjg.v10.i22.3369
Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner
Yang-Chun Zheng, Yu-Ying Tang, Zong-Guang Zhou, Li Li, Tian-Cai Wang, Yi-Ling Deng, Dai-Yun Chen, Wei-Ping Liu
Yang-Chun Zheng, Zong-Guang Zhou, Li Li, Tian-Cai Wang, Department of Gastroenterological Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Ying Tang, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yi-Ling Deng, Dai-Yun Chen, Wei-Ping Liu, Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: All authors contributed equally to the work.
Supported by the National Natural Science Foundation of China, No. 39925032
Correspondence to: Dr. Zong-Guang Zhou, Department of Gastroenterological Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. zhou767@21cn.com
Telephone: +86-28-85422484 Fax: +86-28-85422484
Received: March 9, 2004
Revised: April 1, 2004
Accepted: April 5, 2004
Published online: November 15, 2004
Abstract

AIM: To investigate the number, size, and status of lymph nodes within the mesorectum and to explore the prognostic significance of lymph node micrometastases in patients with rectal cancer.

METHODS: Thirty-one patients with rectal cancer undergone total mesorectal excision between October 2001 and October 2002 were included. Mesorectal nodes retrieved from the resected specimens were detected with a combination of haematoxylin and eosin (HE) staining and immunohistoch-emistry (IHC). The relations between lymph node metastases, micrometastases and postoperative recurrence were analyzed.

RESULTS: A total of 548 lymph nodes were harvested, with 17.7 ± 8.2 nodes per case. The average number of metastatic nodes in HE-positive patients and micrometastatic nodes in IHC-positive patients was 5.2 ± 5.1 per case and 2.2 ± 1.3 per case, respectively. The mean size of all nodes and metastatic nodes was 4.1 ± 1.8 mm and 5.2 ± 1.7 mm in diameter, respectively. The mean size of micrometastatic nodes was 3.9 ± 1.4 mm in diameter. The size of the majority of mesorectal nodes (66.8%), metastatic nodes (52.6%), and micrometastatic nodes (79.5%) was less than 5 mm in diameter. During a median follow-up period of 24.6 ± 4.7 mo, 5 patients (16.7%) had recurrence, of them 2 died and 3 survived. Another case died of tumor unrelated cause and was excluded. All 5 recurrent cases had 3 or more nodes involved, and one of them developed only lymph node micrometastases. The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent groups (P < 0.01 and P = 0.01, respectively).

CONCLUSION: The majority of lymph nodes, metastatic, and micrometastatic lymph nodes within the mesorectum are smaller than 5 mm in diameter. The nodal status and the number of lymph nodes involved with tumor metastases and micrometastases are related to the rapid postoperative recurrence.

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