Distribution and patterns of lymph nodes metastases and micrometastases in the mesorectum of rectal cancer

Abstract

Most of the metastases and micrometastases positive lymph nodes were smaller than 5 mm and distributed along the SRA. The patterns of lymph nodes spread were related to the circumferential situation of tumor in the rectal wall. Surgical excision of the rectal cancer should completely remove the whole mesorectum, especially to avoid any damage of the mesorectum on tumor side.

Prognostic impact of lymph node skip metastasis in Stage III colorectal cancer

“…The occurrence of LNSM may be explained as follows. First, occult metastasis or micrometastasis to the LND1 station may be missed during a routine histopathological examination [35,[38][39][40][41][42]. Second, early lymphatic spread to a draining LN through aberrant drainage may cause distant nodes to be positive but those closer to the tumour to be negative [43][44][45].…”

IGRT in rectal cancer

“…The mesorectum, defined as the lymphovascular fatty tissue lying around the rectal wall, is recognized to be the main site of rectal tumour spread because of the absence of anatomical borders. The majority of mesorectal nodes seem to lie along the sigmoid rectal artery and its branches and the patterns of spread are related to the tumour position in the rectal wall [21,22].…”

One Size Does Not Fit All: Planning Volumes for Radiotherapy in Rectal Cancer—Should We Tailor Radiotherapy Fields to Stage and Risk?

“…The majority of lymph nodes appear to be located proximally to the tumor above the peritoneal reflection [30], and in the posterior aspect along the trunk of the superior rectal artery [31][32][33][34]. Other studies report only 26% of nodes below the peritoneal reflection and only 8% in lower third of the mesorectum .…”