Determination of Operative Procedure Based on Preoperative Examination of Rectal Cancer

Hiroharu Isomoto, Kazuo Shirouzu, Tatsuhisa Morodomi, Yuichi Yamashita, Teruo Kakegawa

First Department of Surgery, Kurume University School of Medicine

Recently, surgery for rectal cancer has been concerned not only with radicality, but also with improving the quality of life by preserving defecatory, urinary and sexual functions. Consequently, various imaging techniques in addition to biopsy are used preoperatively to determine the best operative procedure. It is important to know (1) the location and size of the tumor, (2) the depth of invasion into the rectal wall and infiltration into another organ. (3) whether there is lymph node metastasis or not, (4) the length of distal invasion, and (5) whethere or not there are remote metastatic foci and peritoneal dissemination. The results of X-ray image accurately judgment the depth of invasion into the wall, while a transanal ultrasonic examination was effective for determining the depth of m, sm, or pm. MRI was useful for assessing the depth of a₂ or ai. Distal invasion and lymph node metastasis were effectively predicted by the degree of tissue differentiation from preoperative biopsy specimens. Lymphatic vessel invasion and budding (microtubular cancer nests and undifferentiated cancer cells) were indispensable to determine the AW distance for dicidig the surgical margin.

Key words
biopsy, budding

Reprint requests
Hiroharu Isomoto First Department of Surgery, Kurume University School of Medicine
67 Asahi-machi, Kurume, 830 JAPAN

Accepted
November 20, 1991

To read the PDF file you will need Abobe Reader installed on your computer.