Lymphangiography in the diagnosis of retroperitoneal node metastases in rectal cancer

Conservative treatment of rectal cancer. Extending the indications

Rectal cancer often in the past was believed to require abdominoperineal resection with permanent colostomy to achieve a cure. Several surgical alternatives to colostomy currently are available for selected patients. Understanding of the methods of preoperative staging is increasing, and new techniques, such as intrarectal ultrasound, have provided improved accuracy. By applying this and other methods of preoperative staging, selection of a surgical approach appropriate to the tumor stage increasingly is possible. Curative treatment for rectal cancer often can be achieved while preserving anorectal function.

When should radiotherapy be given for rectal cancer?

There are a number of reasons why radiotherapy is better given before rather than after radical surgery for rectal cancer. When this policy is adopted, however, two related problems arise. First, how are patients requiring radiotherapy to be selected? Second, how are irradiated patients to be compared with unirradiated patients stage by stage in clinical trails? It is suggested that the Dukes' staging system in inappropriate for both, and that a clinical staging system for rectal cancer is urgently required to solve both these problems. The way in which such a staging system might be developed is indicated. In the meantime trials of adjuvant radiotherapy for carcinoma of the rectum should be interpreted with caution for two reasons. First, a reduction in local recurrence may not necessarily be reflected in a reduction in death rates. Second, since the origin of local recurrence is obscure, the radiation dose to the regional lymph nodes should be recorded carefully.

Reliability and Value of Diagnostic Lymphography in Carcinoma of the Sigmoid, Rectum and Anus

From 1963 to 1973, 253 patients with cancer of the sigmoid, rectum and anus underwent diagnostic lymphography at the Istituto Nazionale Tumori of Milan. In 218 patients lymphography was performed as part of the initial diagnostic work-up, while in 35 it was done during the follow up period, after surgery. The accuracy of radio-histological correlation was 95 %. This confirms the reliability of diagnostic lymphography and its clinical usefulness. In view of these results, this diagnostic tool is essential in the initial evaluation in patients with carcinoma of the anus, because lymphography was superior (28 %) to the clinical inspection (6 %) in the evaluation of the inguino-iliac lymph nodes. Lymphography is also useful in rectal cancer since it permits, in case of nodal metastases, selection of a group of patients in whom the therapeutic program should be revised. The exam is useless in cancer of the sigmoid. In the small group of patients who had lymphography in the follow up period, this technique was the only to show, in symptomatic patients, the presence of pelvic and/or para-aortic nodal metastases. Lymphography is also useful in these patients for the evaluation of the results of the radio/chemotherapy on involved nodes.