J Korean Surg Soc.  2010 May;78(5):298-304. 10.4174/jkss.2010.78.5.298.

Clinicopathologic Analysis of Mesorectal Spread of Rectal Cancer with Whole Mount Section

• Kim SJ
• Choi YJ
• Kang JG

• KMID: 2211956
• DOI: http://doi.org/10.4174/jkss.2010.78.5.298

Abstract

PURPOSE
Total mesorectal excision (TME) has been widely accepted as the principal method in rectal cancer surgery and demonstrates good oncologic and functional outcome. The recurrence rate of mid-low rectal cancer surgery with TME is reported as 5~6%. Concerning local recurrence, remaining microscopic nodules in mesorectum are a major issue. In this study, we investigated mesorectal spread of tumors and exact lateral resection margin using whole mount section (WMS) to obtain correlations with other clinico-pathological variables.
METHODS
63 rectal cancer patients underwent surgery with TME and WMS at National Health Insurance Corporation Ilsan Hospital between December 2005 and October 2008. Preoperative study was made by computed tomography (CT), magnetic resonance imaging (MRI). We measured the distance from the largest cut section of the primary tumor to the nearest circumferential margin using MRI and compared them to lateral resection margins in WMS.
RESULTS
Among 63 patients, the sex ratio was 1:1.17 and the median age was 62.7 years. There were 34 patients in TNM stage III (54.0%), 21 patients in stage II (33.3%) and 8 patients in stage I (12.7%). Lateral margin involvement was predicted in 4 cases pre-operatively and confirmed in 3 cases with WMS. Micrometastasis in mesorectum was detected in 6 patients (9.5%) and all were in stage III. N stage was statistically correlated with micrometastasis (P=0.016).
CONCLUSION
WMS offers precise lateral resection margin and mesorectal spread of microscopic tumor nodules. WMS is best considered in stage III cancer to evaluate mesorectal micrometastasis. The mid-low rectal cancer cases with predicted lateral margin involvements using MRI should be operated on with great care.

Keyword

Whole mount section; Total mesorectal excision; Circumferential resection margin

MeSH Terms

Humans
Magnetic Resonance Imaging
National Health Programs
Neoplasm Micrometastasis
Rectal Neoplasms
Recurrence
Sex Ratio

Figure

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  Fig. 1 MRI measurement: The image shows measurement of the closest circumferential distance between tumor and rectal proper fascia.

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  Fig. 2 Preparation of whole mount section specimen. (A) The total mesorectal excision (TME) specimen was fixed in formalin without cutting. (B) After 1st fixation, the TME specimen was cut vertically along the long-axis evenly at 5 mm each.

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  Fig. 3 Whole mount section slide: The H&E stained slide shows main tumor mass, depth of tumor invasion, regional lymph node and discontinuous micrometastasis in mesorectum (black arrow = primary tumor; green double-arrow, the closest distance between tumor and CRM; blank arrow = discontinuous microscopic tumor nodule in mesorectum; blank arrow head, posterior wall of uterus).

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