This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Origin of presacral local recurrence after rectal cancer treatment. BJS 2010; 97: 1582-1587.
Published: 16th July 2010
Authors: M. Kusters, C. Wallner, M. M. Lange, M. C. DeRuiter, C. J. H. van de Velde, Y. Moriya et al.
Background
The objective of this study was to obtain detailed anatomical information about the lateral lymph nodes, in order to determine whether they might play a role in presacral local recurrence of rectal cancer after total mesorectal excision without lateral lymph node dissection.
Method
Ten serially sectioned human fetal pelvises were studied at high magnification and a three‐dimensional reconstruction of the fetal pelvis was made.
Results
Examination of the histological sections and the three‐dimensional reconstruction showed that lateral lymph node tissue comprises a major proportion of the pelvic tissue volume. There were no lymph nodes located in the presacral area. Connections between the mesorectal and extramesorectal lymph node system were found in all fetal pelvises, located below the peritoneal reflection on the anterolateral side of the fetal rectum. At this site middle rectal vessels passed to and from the mesorectum, and branches of the autonomic nervous system bridge to innervate the rectal wall.
Conclusion
The findings of this study support the hypothesis that tumour recurrence might arise from lateral lymph nodes. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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