Risk Factors of Lymph Node Metastasis in Colorectal Cancer, Invading to Submucosal Layer

Koji Asai, Seiji Igarashi^*, Takashi Matsui, Jun Horiguchi^** and Kenjiro Kotake

Department of Surgery, Tochigi Cancer Center
^*Department of Pathology, Tochigi Cancer Center
^**Department of Diagnostic Imaging, Tochigi Cancer Center

Objective: To investigate the indications for lymph node dissection in cases with submucosal invasive colorectal cancer, we examined the clinicopathological factors related to lymph nodemetastasis. Methods: We identified 113 cases of submucosal invasive colorectal cancer receiving D1 or greater extended lymph node dissection. Among these cases, 13 clinicopathological factors were examined in relation to lymph node metastasis. Results: Lymph node metastasis was observed in 14 cases (12.4%). A univariate analysis showed that the vertical depth of the submucosal invasion, the width of submucosal invasion, budding and lymph vessel invasion (ly) were significantly associated with lymph node metastasis. A multivariate analysis showed that among these four factors, ly and budding related to lymph node metastasis. Budding and ly also showed a significant correlation. Conclusion: Neither ly nor budding was observed in cases where the tumor invasion was less than 1 mm in depth and less than 3 mm width. Therefore, these cases can probably be curatively treated by endoscopic resection alone. Furthermore budding appears to be an important predicting factor of ly and lymph node metastasis.

Key words
colorectal cancer, submucosal invasion, lymph node metastasis, budding

Reprint requests
Koji Asai Tochigi Cancer Center 4-9-13 Yohnan, Utsunomiya, 320-0834 JAPAN

Accepted
April 30, 2003

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