The Characteristics Of Lateral Node Metastasis In Rectal Cancer

The rectal cancer is a kind of common malignant tumor of digestive system and the morbility is the forth in the world. In nearly ,the morbility and montality of rectal cancer is going up in global. Surgical therapy gains an overwhelming majority advancement. Basing on biology behavior of rectal cancer, surgical therapy has transformed from traditional pattern to modern surgical treatment. It isn't only radical treatment and decreasing local recurrence but also defending the function of bowels and generation are needed. The methods of operation include total mesoretal excision, protecting pelvic splanchnic nerve in the operation of recrum carcinoma and so on.This change bases on the characteristics of lateral node metastasis in rectal cancer. Directions of lymph contain anodic node,lateral node and inferior node.The first stand lymph node is lymphonodi mesenterici. Most scholars consider that the principal route of lymph metastasis is anodic node ,but seldom inferior node is metastasis. In 1927, a Japanese scholar found directions of lateral node with injecting Methylt- hioninium Chloride. But there are many different standpoints about the rate of lateral node metastasis. Major views of lateral node metastasis are that the most important factor is distant of tumor from anus. All of lateral node metastasis size is distant of the return of peritoneum. The anodic and lateral node metastasis in rectal cancer do not relate, unless distant of tumor from anus is over 5 centemetre. And they think if both were metastasis, the patient would have been advanced stage. So about metastasis of low-set pimeloma is still lateral node. But metastasis of superior segment pimeloma is anodic node. Base on result of Japanese, the rate of lateral node metastasis is approximate 10%-16%, and it directly affect the rate of locoregional recurrence and life span of patient. So Japanese socholars consider it should clean lateral node to protract patients life span. But European socholars with a lot of investigation think the rate of lateral node metastasis is low. Total mesoretal excision and cleaning anodic node could be standard of radical correction of rectal cancer. They think cleaning lateral node could not protract patients life span, on contrary, could increase the rate of concurrent disease and operation risk. Two contradistinction standpoints of lateral node becomes long-term dispute. Recently scholars of our country has studied lateral node, but the result is still different.Base on resent study result and the most important argument, we design this empirical study, at this time, the experiment motive is to direct operation therapy and improve patients'quality and period of life with studying the characteristics of node metastasis in rectal cancer, especially lateral node and sacral lymph node. All of patients in experiment is severitily selected. It contains hemog- olobin and plasma-albumin content,liver and renal function, nutr- itional state and so on. All physiological conditions is almost at equal pace besides categorization targets. Base on sex, age, path- type, Duck's stage, distance of tumor from anus, 40 patients are selected and compared to analysis status of every node group. Res- ult :①Totally,307 nodes of lymphonodi mesenterici has been got from 40 rectal cancer patients,and 65 nodes are metastasis nodes. 15 patients of all has been diagnosed metastasis nodes of lympho- nodi mesenterici.The metastasis rate is 37.5%.②142 nodes has been cleaned from arteria mesenterica inferior,and metastasis nod- es is 22。9patients'nodes are metastasis.The rate is 22.%.③443 la- teral nodes has been cleaned .It contains 75 nodes from caval vein, 34 nodes from parraaortic lymph node, 105 nodes from obturator lymph nodes, 53 nodes from external iliac lymph nodes,46 nodes from common iliac lymph nodes, 35 nodes from internal lymph nodes,95 nodes from sacral lymph nodes.Only is one patient metastasis.(Patient's information: female,40 years old, Duck's D stage, tumor's distance from anus being 5 centimeter) .④None of 95 sacral lymph nodes is metastasis.So our opinion is that the most important lymph node metastasis path is anodic node. It contains lymphonodi meseterici and arteria mesenterica inferior. Lateral node metastasis rate is lower. Sacral lymph nodes metas- tasis is not obvious. This result is the same with European scholar study, so we think cleaning lateral node is not have important clinic significance.