Distal intramural spread of rectal cancerDistale intramurale Tumorausbreitung beim Rektumkarzinom

BACKGROUND: The Czech Republic is one of the countries with the highest incidence of rectal cancer. Distal intramural spread below the palpable edge of a rectal cancer is unusual and a sign of very advanced or highly malignant disease. Submucosal spread occurs in approximately 10% of cases and indicates poor prognosis, regardless of type of operation. The aim of the prospective study was to monitor surgical treatment of patients with rectal cancer. Certain oncologic aspects were considered – mainly the safety distance of the lower resection line during the operation and distal intramural spread of rectal cancer. METHODS: In our study we focused on patients with rectal cancer who were operated at the Department of Surgery at the University Hospital of Ostrava within a period of three years (from 2000 to 2002). During this time, 188 patients with rectal cancer were treated in our institution. During the study, we closely cooperated with the Pathological Anatomic Institute of the University Hospital of Ostrava, where the specimens were carefully investigated according to oncologic criteria. Each specimen was examined for microscopic spread distal to the aboral tumor edge at standard distances, i.e., 2 mm, 5 mm, 1 cm, 2 cm and 5 cm. Histopathologic data obtained at different distances were assessed and compared with a recent series. RESULTS: Our data show that submucosal tumor spread decreased at increasing distances from aboral tumor margin, an observation going in line with the literature. Submucosal tumor spread has been assessed in 11.8% of cases. Tumor spread was not found lower than 5 cm below the bottom margin of the tumor. Microscopic spread below the bottom margin of the tumor was observed in medium or low differentiated adenocarcinoma. Distal spread of well differentiated adenocarcinoma was not found. CONCLUSIONS: Results of our study we consider worthy of being forwarded to the general medical community.