Microscopic spread of low rectal cancer in regions of mesorectum:Pathologic assessment with whole-mount sections  

作　　者：ZhaoWang Zong-GuangZhou CunWang Gao-PingZhao You-DaiChen Hong-KaiGao Xue-LianZheng RongWang Dai-YunChen Wei-PingLiu 

机构地区：[1]DepartmentofGastroenterologySurgeryandInstitutionofDigestiveSurgery,WestChinaHospital,SichuanUniversity,Chengdu610041,SichuanProvince,China [2]DepartmentofPathology,WestChinaHospital,SichuanUniversity,Chengdu610041,SichuanProvince,China

出　　处：《World Journal of Gastroenterology》2004年第20期2949-2953,共5页世界胃肠病学杂志（英文版）

基　　金：Supported by the Key Project of National Outstanding Youth Foundation of China,No.39925032 and National Natural Science Foundation of China,No.30271283

摘　　要：AIM: To assess the microscopic spread of low rectal cancer in mesorectum regions to provide pathological evidence for the necessity of total mesorectal excision (TME). METHODS: A total of 62 patients with low rectal cancer underwent low anterior resection and TME, surgical specimens were sliced transversely on the serial embedded blocks at 2.5 mm interval, and stained with hematoxylin and eosin (HE). The mesorectum on whole-mount sections was divided into three regions: outer region of mesorectum (ORM), middle region of mesorectum (MRM) and inner region of mesorectum (IRM). Microscopic metastatic foci were investigated microscopically on the sections for the metastatic mesorectal regions, frequency, types, involvement of lymphatic vessels and correlation with the original rectal cancer. RESULTS: Microscopic spread of the tumor in mesorectum and ORM was observed in 38.7% (24/62) and 25.8% (16/62) of the patients, respectively. Circumferential resection margin (CRM) with involvement of microscopic metastaticfoci occurred in 6.5% (4/62) of the patients, and distal mesorectum (DMR) involved was 6.5% (4/62) with the spread extent within 3 cm of low board of the main lesions. Most (20/24) of the patients with microscopic metastasis in mesorectum were in Dukes C stage. CONCLUSION: Results of the present study support that complete excision of the mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer, an optimal DMR clearance resection margin should be no less than 4 cm, further pathologic assessment of the regions in extramesorectum in the pelvis is needed.AIM:To assess the microscopic spread of low rectal cancer in mesorectum regions to provide pathological evidence for the necessity of total mesorectal excision(TME). METHODS:A total of 62 patients with low rectal cancer underwent low anterior resection and TME,surgical specimens were sliced transversely on the serial embedded blocks at 2.5 mm interval,and stained with hematoxylin and eosin(HE). The mesorectum on whole-mount sections was divided into three regions:outer region of mesorectum(ORM),middle region of mesorectum(MRM)and inner region of mesorectum (IRM).Microscopic metastatic foci were investigated microscopically on the sections for the metastatic mesorectal regions,frequency,types,involvement of lymphatic vessels and correlation with the original rectal cancer. RESULTS:Microscopic spread of the tumor in mesorectum and ORM was observed in 38.7%(24/62)and 25.8%(16/62) of the patients,respectively.Circumferential resection margin(CRM)with involvement of microscopic metastatic foci occurred in 6.5%(4/62)of the patients,and distal mesorectum(DMR)involved was 6.5%(4/62)with the spread extent within 3 cm of low board of the main lesions. Most(20/24)of the patients with microscopic metastasis in mesorectum were in Dukes C stage. CONCLUSION:Results of the present study support that complete excision of the mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer,an optimal DMR clearance resection margin should be no less than 4 cm,further pathologic assessment of the regions in extramesorectum in the pelvis is needed.

关 键 词：显微镜 低的直肠癌 直肠系膜 病理学 横切面 

分 类 号：R735.37[医药卫生—肿瘤] R361.2[医药卫生—临床医学]