[Lymph node metastasis in early rectal tumors]

Sixteen patients with early rectal carcinoma seen between January 1981 and May 1991 have been reviewed to determine the lymph node involvement (histopathological examination of the lymph nodes) and its implications for subsequent treatment. The mean age was 63 years (from 38 to 79; 10 male, six female). The site of the tumor was predominantly in the lower rectum (56.2%). The polypoid and flat-elevated ulcerated (IIa + IIc) subtype were detected in nine and seven lesions respectively. Sphincter-saving techniques were carried out in 62.5% of cases, and only five patients (31.2%) required Miles' operation. Neither postoperative complication nor death were noted. The mean follow-up period was 57 months (6 to 133 months). No recurrence or distal metastasis were found during this follow-up period. The results had shown close relation between the depth of submucosal invasion and IIa+IIc subtype lesions with lymphovascular infiltration. Although this kind of association was not accompanied by an increased number of involved lymph nodes, major surgical resection is suggested in such cases due to the risk of lymph node metastasis when invasion into the submucosa reaches the Sm1c level or deeper.