title: Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm.
abstract: BACKGROUND
  The question of whether manual dissection when searching for metastatic lymph nodes from rectal cancer (less than 5 mm) is a reliable method remains controversial.
  
  
  METHODS
  We examined 50 consecutive cases of primary adenocarcinoma of the rectum treated with a sphincter-sparing total rectum resection, total mesorectum excision, and coloanal anastomosis. We used a manual method for the detection of lymph nodes.
  
  
  RESULTS
  One thousand seven hundred ninety-three lymph nodes were found (mean, 36 per patient). One hundred seventy-four contained metastases. Seventy-nine (45.4%) of the affected lymph nodes were less than 5 mm in greatest dimension. The percentage of metastases to small lymph nodes was similar to the percentage reported by Kotanagi (50%), but lower than the report of Herrera (78%), who used a clearing technique to search for regional lymph nodes.
  
  
  CONCLUSIONS
  A median 17 months follow-up in these patients demonstrated that metastases in small lymph nodes are important in the accurate staging of rectal tumors and that a manual method of searching for small lymph nodes is reliable.
authors.affiliation: Division of Pathology and Citology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Andreola
authors.forename: E
authors.initials: E
authors.lastname: Leo
authors.forename: F
authors.initials: F
authors.lastname: Belli
authors.forename: R
authors.initials: R
authors.lastname: Bufalino
authors.forename: G
authors.initials: G
authors.lastname: Tomasic
authors.forename: C
authors.initials: C
authors.lastname: Lavarino
authors.forename: M T
authors.initials: MT
authors.lastname: Baldini
authors.forename: E
authors.initials: E
authors.lastname: Meroni
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies