[Malignant polyps and early recognized carcinomas of the rectum. Morphological aspects and selective surgical...

The lymphatic drainage of the colon and rectum originates in the submucosal layer. Therefore metastases do not arise from carcinomas confined to the mucosa, and for the same reason the WHO lately recommended to call these lesions severe atypism. The term adenocarcinoma should be reserved in the case of infiltration of the carcinoma into the submucosa. According to the features outlined above adenomas of the rectum showing severe atypism can be removed by careful excision of the mucosa. Even adenomas containing an early diagnosed adenocarcinoma up to 2.5 cm in diameter often can be cured by a local resection of the rectal wall, if no metastases have occurred. From 1971--December 1, 1977, 12 rectal adenomas with severe atypism and 14 rectal adenomas with adenocarcinoma had been removed locally without complications. After 6 years there was no recurrence of carcinoma.