title: Identifying rectal carcinoma with distal submucosal spread.
abstract: OBJECTIVE
  This study was designed to find features that would preoperatively identify a high risk of distal submucosal spread in patients with rectal carcinoma.
  
  
  METHODS
  The resected specimens of 124 patients with rectal carcinoma were prospectively examined for submucosal spread. The results were correlated with patho-anatomical, histological, and operative findings.
  
  
  RESULTS
  There were 64 male and 60 female patients with a mean age of 62 years. Distal submucosal spread was detected in four (3%) patients, all with Dukes' C or disseminated carcinoma and macroscopic and microscopic signs of advanced and aggressive tumour growth. In particular, all cases had advanced lymph node involvement (N3, P=0.0005) and all tumours were classified as poorly differentiated (P=0.0002). The presence of both features gave a 31% chance of distal submucosal spread in our series.
  
  
  CONCLUSIONS
  Distal submucosal tumour spread is associated with poorly or undifferentiated tumours and advanced lymph node involvement. Preoperative identification of patients at risk of distal submucosal spread requiring more extensive distal clearance is possible.
authors.affiliation: Department of Colorectal Surgery, Singapore General Hospital, Singapore, Department of Histopathology, Singapore General Hospital, Singapore.
authors.lastname: Kraemer
authors.lastname: Seow-Choen
authors.lastname: Ho
authors.lastname: Eu
authors.lastname: Ho