Japanese Journal of Clinical Oncology, Vol 28, Issue 6 378-382, Copyright © 1998 by Foundation for Promotion of Cancer Research
Y Yamamoto, K Takahashi, M Yasuno, T Sakoma and T Mori
BACKGROUND: We have sometimes experienced cases of colorectal cancer with
skipping lymph node metastasis in which distant nodes were positive but
those closer to the tumor were negative. There have been few reports of
this condition and its clinical characteristics have not been clarified.
This study was conducted to clarify the status of skipping lymph node
metastasis and its clinicopathological characteristics in colorectal
cancer. METHODS: We analyzed 452 patients with colorectal cancer and nodal
metastases (270 with colon cancer and 182 with rectal cancer). All the
resected nodes were examined using histological procedures with a
microscope and were classified by their location according to the General
Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum
and Anus. We studied the status of skipping nodal status and the
correlation between the nodal status and clinicopathological findings,
including the disease-free survival, depth of tumor, histological type,
staging and recurrence. RESULTS: Twenty-eight (10.4%) of the colon cancer
patients and 20 (11.0%) of the rectal cancer patients were found to have
skipping nodal metastases. In rectal cancer patients with n2 (nodal
metastases at the N2 site) in the direction of the main node, patients with
skipping lymph node metastases had a significantly better prognosis than
those without (p = 0.026). In all colon cancer patients and rectal cancer
patients with lateral n3 (nodal metastases at the lateral N3 site), there
were a tendency for those with skipping nodal metastases to have better
disease-free survival rates (p = 0.1). Also, the mean number of positive
nodes in skipping cases was significantly lower than that in non-skipping
cases. In addition, skipping nodal metastases in rectal cancer suggested a
possibility of bypass flow which was not generally recognized. CONCLUSION:
These findings in colorectal cancer suggest the presence of previously
unknown lymphatic tracts and that the cancers concerned have a better
prognosis than those without skipping nodal metastases.
ORIGINAL ARTICLE
Clinicopathological characteristics of skipping lymph node metastases in patients with colorectal cancer
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Japan. yutaka-y@worldnet.att.net
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