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Updated: Aug 15, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Tumor budding and evidence-based treatment of T2 rectal carcinomas
Tadahiko Masaki1, Hiroyoshi Matsuoka, Masanori Sugiyama
1Department of Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka city, Tokyo, Japan. masaki@kyorin-u.ac.jp
Background:
The validity of the histological criteria in deciding additional bowel resection after local excision of T2 rectal carcinomas is questioned.
Methodology:
In 72 T2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (LNM) and clinicopathologic parameters were examined statistically, a prediction formula for LNM was constructed and decision analysis was attempted.
Results:
Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with LNM. The probability of LNM can be calculated as follows; Z = 0.037 x (budding number) + 2.08 x (SEX; male, 1; female, 2) - 5.736; Probability = 1/1 + e(-Z). When a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. If a number of tumor budding is 0, the risk of LNM is calculated as 2.4% in a male and 17.1% in a female patient. On the assumption that the risk of liver metastasis is half of that of LNM, and the salvageabilities after LNM and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient.
Conclusions:
A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.
