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Metastasis of rectal cancer to lymph nodes and tissues around the autonomic nerves spared for urinary and sexual
1Second Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Purpose:
To clarify the indications for autonomic nerve-sparing operations for rectal cancer, the presence of lymph nodes and metastasis in the tissue around the autonomic nerve were examined in 28 rectal cancer patients. These were staged as pT2 in 8 patients, pT3 in 19 patients, and pT4 in 1 patient histopathologically.
Methods:
The specimens of the autonomic nerve including the inferior mesenteric plexus, preaortic plexus, superior hypogastric plexus, hypogastric nerve, and pelvic plexus were removed with radical abdominopelvic lymphadenectomy after the autonomic nerve-sparing rectal cancer operation.
Results:
In the tissue around the autonomic nerve, lymph nodes were 11.2 +/- 9.6 in number and 2.6 +/- 2.4 mm in size (mean +/- standard deviation). The frequency of presence of lymph nodes was higher and the number of lymph nodes was larger in the inferior mesenteric plexus (70.4 percent; 3.6) and the preaortic plexus (66.7 percent; 2.1) than in the left and right pelvic plexuses (39.1 percent, 1; 36 percent, 1). Metastasis to the lymph nodes or lymphatic permeation in the tissue around the autonomic nerve were observed in four cases (14.3 percent) of lower rectal cancer, consisting of three with Stage III cancer (pT3, pN1-3, and M0) and one with Stage IV cancer (pT4, pN1, and pM1 (HEP)).
Conclusion:
Radical rectal excision that includes lymph nodes and adjacent tissue around the autonomic nerves may result in metastatic tumor removal that would otherwise be left in situ with nerve-sparing techniques for advanced rectal cancer in Stage III.
Insights
Autonomic nerve-sparing surgery for rectal cancer can leave lymph nodes with metastasis in situ. Radical excision including autonomic nerve tissue may improve tumor removal in advanced rectal cancer.
Area of Science:
- Oncology
- Surgical Oncology
- Anatomy
Background:
- Autonomic nerve-sparing surgery is crucial for preserving function in rectal cancer operations.
- The extent of autonomic nerve involvement by rectal cancer requires further investigation to optimize surgical margins.
Purpose of the Study:
- To investigate the presence and characteristics of lymph nodes and metastasis within the autonomic nerve tissue surrounding rectal tumors.
- To determine the implications for surgical indications of autonomic nerve-sparing procedures in rectal cancer.
Main Methods:
- Histopathological examination of autonomic nerve specimens (inferior mesenteric plexus, preaortic plexus, hypogastric plexus, hypogastric nerve, pelvic plexus) from 28 rectal cancer patients.
- Analysis of lymph node presence, size, and metastatic involvement in relation to tumor stage (pT2, pT3, pT4).
Main Results:
- Lymph nodes were frequently found within the autonomic nerve tissue, particularly in the inferior mesenteric and preaortic plexuses.
- Metastasis or lymphatic permeation in autonomic nerve-associated tissues was observed in 14.3% of lower rectal cancer cases, including Stage III and Stage IV disease.
- The presence and size of lymph nodes varied across different autonomic nerve plexuses.
Conclusions:
- Autonomic nerve-sparing techniques alone may be insufficient for complete tumor removal in advanced rectal cancer (Stage III and IV).
- Radical rectal excision encompassing lymph nodes and adjacent autonomic nerve tissue is recommended for advanced rectal cancer to ensure adequate oncologic resection.