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Updated: May 12, 2026
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Identifying rectal carcinoma with distal submucosal spread
Kraemer1, Seow-Choen, Ho
1Department of Colorectal Surgery, Singapore General Hospital, Singapore, Department of Histopathology, Singapore General Hospital, Singapore.
Objective:
This study was designed to find features that would preoperatively identify a high risk of distal submucosal spread in patients with rectal carcinoma.
Patients And Methods:
The resected specimens of 124 patients with rectal carcinoma were prospectively examined for submucosal spread. The results were correlated with patho-anatomical, histological, and operative findings.
Results:
There were 64 male and 60 female patients with a mean age of 62 years. Distal submucosal spread was detected in four (3%) patients, all with Dukes' C or disseminated carcinoma and macroscopic and microscopic signs of advanced and aggressive tumour growth. In particular, all cases had advanced lymph node involvement (N3, P=0.0005) and all tumours were classified as poorly differentiated (P=0.0002). The presence of both features gave a 31% chance of distal submucosal spread in our series.
Conclusion:
Distal submucosal tumour spread is associated with poorly or undifferentiated tumours and advanced lymph node involvement. Preoperative identification of patients at risk of distal submucosal spread requiring more extensive distal clearance is possible.
