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The significance of histopathologic findings in the submucosal invasive front of early colorectal carcinoma in terms of regional lymph node metastasis and tumor recurrence


, : The significance of histopathologic findings in the submucosal invasive front of early colorectal carcinoma in terms of regional lymph node metastasis and tumor recurrence. Stomach & Intestine 29(11): 1143-1150

The histopathologic findings in the submucosal invasive front of 131 early colorectal cancer patients, who underwent curative bowel resection with lymph node dissection, were investigated retrospectively in terms of their significance as predictors of regional lymph node metastasis and tumor recurrence. Twenty patients (15.3%) had regional lymph node involvement at the time of the primary operation, 10 patients (7.6%) developed tumor recurrence, mainly hepatic metastasis, after curative resection. Five histopathologic findings showed significantly higher rates of lymph node metastasis respectively, compared to those without these findings. They were: 1) middle or deep submucosal tumor invasion (sm-2.3), 2) moderate or poor tumor differentiation in the submucosal invasive front, 3) poorly demarcated cancer growth at invasive front (INF-beta), 4) tumor budding ahead of invasive front, and 5) vessel permeation. These 5 factors were thus considered as risk factors possibly leading to regional lymph node metastasis. Whereas patients with ltoreq 3 risk factors had no nodal spread, the rate of lymph node involvement with gtoreq 4 was 42.6%. As for tumor recurrence after curative resection, four pathologic findings: a) nodal involvement, b) sm-2.3, c) INF-beta, and d) venous permeation were considered as risk factors. While patients with ltoreq 1 risk factors had no tumor recurrence, those with gtoreq 2 showed a recurrence rate of 15.4%. It is concluded that histopathologic findings in the submucosal invasive front in early colorectal carcinoma are very useful for the prediction of the high risk group for lymph node metastasis and tumor recurrence.

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