Distant Metastasis of Colorectal Cancer that Extend into Only Muscularis Propria -A Clinico Pathological Study-

Takashi Itoh, Takayuki Morita, Fumihiko Nakamura, Mitsuru Konn

Department of Surgery, School of Medicine, Hiroaki University

To determine the histological predictors of distant metastasis of advanced colorectal cancer that extends into only the muscularis propria, 119 patients wer examined clinically and histopathologically. Distant metastasis was found in 14 patients, and in 100 patients, there was no metastasis or local recurrence. Three patients with local recurrence, one patient with peritoneal dissemination and one patient with paraaortic lymph node metastasis were excluded from this study. Six clinicopathological charactaristics were identified as risk factors for distant metastasis: 1) tumor in proctos; 2) moderately differentiated adenocarcinoma; 3) invasion of the tumor into the outer longitudinal muscle; 4) prominent tumor budding (small clusters of undifferentiated cancer cells ahead of the invasive front); 5) vascular embolization by tumor cells in medium-sized vessels. 6) lymph node metastasis. In contrast, the cumulative survival rate for patients with no risk factor was 100%, and the survival rates for patients with one, two and more than three positive factors were 97.6%, 81.9%, 53.1% (p<0.05) respectively. To perform appropriate adjuvant chemotherapy in relatively early advanced colorectal cancer, it is useful to predict distant metastasis by histological examination.

Key words
colorectal carcinoma invading muscularis propria, distant metastasis of colorectal carcinoma, clinicopathological study

Reprint requests
Takashi Itoh: Department of Surgery, School of Medicine, Hirosaki University
5 Zaihucho, Hirosaki, 036 JAPAN

Accepted
November 13, 1996

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