Andreola S, Leo E, Belli F, Lavarino C, Bufalino R, Tomasic G, Baldini M T, Valvo F, Navarria P, Lombardi F
Division of Pathology and Cytology, Instituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
Dis Colon Rectum. 1997 Jan;40(1):25-9. doi: 10.1007/BF02055677.
This study was designed to evaluate the frequency of microscopic distal intramural spread in rectal adenocarcinoma and its correlation to other histopathologic prognostic factors.
We examined 55 patients with adenocarcinomas of the lower one-third of the rectum and measured the extent of distal intramural spread in the submucosa and/or muscular layer in comparison with Dukes Stage, diameter of tumor, distance of distal margin of resection from tumor, depth of infiltration into perirectal adipose tissue, nodal status, neoplastic infiltration of lymphatic vessels, blood vessels, and nervous branches.
Distal intramural spread was found in 40 percent of patients, 77 percent of whom had advanced tumors with nodal metastases. Distal intramural spread appeared to be strictly related to tumor size (superior to 40 mm), infiltration of the perirectal adipose tissue, multiple positive lymph nodes, presence of neoplastic emboli in the intramural lymphatic vessels, and neoplastic invasion of the nervous branches. Local recurrence occurred in one Dukes Stage B patient with a positive distal margin of resection and in four patients with a negative distal margin of resection: three Dukes Stage C and one Dukes Stage B patients with neoplastic involvement of the circumferential margin of resection of the mesorectum.
These preliminary data suggest that distal intramural spread may carry little importance in determining local recurrence of rectal adenocarcinoma.
本研究旨在评估直肠腺癌微观远端壁内扩散的频率及其与其他组织病理学预后因素的相关性。
我们检查了55例直肠下三分之一腺癌患者，并测量了黏膜下层和/或肌层中远端壁内扩散的范围，同时与杜克分期、肿瘤直径、肿瘤远端切除边缘距离、直肠周围脂肪组织浸润深度、淋巴结状态、淋巴管、血管和神经分支的肿瘤浸润情况进行比较。
40%的患者发现有远端壁内扩散，其中77%为伴有淋巴结转移的进展期肿瘤。远端壁内扩散似乎与肿瘤大小（大于40mm）、直肠周围脂肪组织浸润、多个阳性淋巴结、壁内淋巴管内肿瘤栓子的存在以及神经分支的肿瘤侵犯密切相关。1例切除边缘远端阳性的杜克B期患者和4例切除边缘远端阴性的患者发生了局部复发：3例杜克C期患者和1例杜克B期患者，其直肠系膜切除的环周边缘有肿瘤累及。
这些初步数据表明，远端壁内扩散在确定直肠腺癌局部复发方面可能不太重要。
