M Tada1, M Endo. 1. First Department of Surgery, Tokyo Medical & Dental University, Japan.
Abstract
PURPOSE: A preoperative evaluation of the lateral lymphatic spread is essential to decide the indication of autonomic nerve preserving operation for rectal cancer. For this evaluation, we used common ultrasonographic examination of the lower abdomen. We also performed this examination on postoperative patients in whom local recurrence had been suspected. Results and effectiveness of examination were evaluated. METHOD: First, we identified arteries in the pelvic cavity (common, external, and internal iliac arteries), and then we sought lymph nodes in the spaces between these arteries, urinary bladder, and rectum. RESULTS: We performed this examination on 40 preoperative patients with rectal cancer and could detect lymph nodes in 12 patients. By the size and features of these lymph nodes, five patients were considered lateral lymphatic spread-positive. After the operation, resected specimens revealed three patients were pathologically positive, and the two others were false-positive. Only one patient was false-negative. Total accuracy of the examination was 92.5 percent; however, the positive lymph node around middle rectal artery and obturator artery had been overlooked. We also performed this examination on postoperative patients in whom local recurrence had been suspected. In one postoperative patient, a recurrent lesion of 3.0 x 3.5 cm in size was detected along the right external iliac artery and could be resected by the retroperitoneal surgical approach. CONCLUSION: We consider this examination very effective for detecting lymph node metastasis preoperatively and recurrent lesions in the pelvic cavity.
PURPOSE: A preoperative evaluation of the lateral lymphatic spread is essential to decide the indication of autonomic nerve preserving operation for rectal cancer. For this evaluation, we used common ultrasonographic examination of the lower abdomen. We also performed this examination on postoperative patients in whom local recurrence had been suspected. Results and effectiveness of examination were evaluated. METHOD: First, we identified arteries in the pelvic cavity (common, external, and internal iliac arteries), and then we sought lymph nodes in the spaces between these arteries, urinary bladder, and rectum. RESULTS: We performed this examination on 40 preoperative patients with rectal cancer and could detect lymph nodes in 12 patients. By the size and features of these lymph nodes, five patients were considered lateral lymphatic spread-positive. After the operation, resected specimens revealed three patients were pathologically positive, and the two others were false-positive. Only one patient was false-negative. Total accuracy of the examination was 92.5 percent; however, the positive lymph node around middle rectal artery and obturator artery had been overlooked. We also performed this examination on postoperative patients in whom local recurrence had been suspected. In one postoperative patient, a recurrent lesion of 3.0 x 3.5 cm in size was detected along the right external iliac artery and could be resected by the retroperitoneal surgical approach. CONCLUSION: We consider this examination very effective for detecting lymph node metastasis preoperatively and recurrent lesions in the pelvic cavity.