title: Small carcinomas involving less than one-quarter of the rectal circumference: local excision is still associated with a high risk of nodal positivity.
abstract: OBJECTIVE
  A study was carried out to determine the relationship between mesorectal lymph nodal involvement and T stage in a group of patients with a rectal cancer involving less than one-quarter of the rectal circumference, such as might be selected for local excision.
  
  
  METHODS
  The data of patients having rectal resection between 2010 and 2014 were prospectively entered in a rectal carcinoma registry. A model for describing tumours involving less than one quadrant of the rectal circumference was created to facilitate the evaluation process.
  
  
  RESULTS
  In all, 304 patients were included in the study. In 68 (22.4%) a small tumour (< 1 quadrant involved) was found. Of these, 26.5% had positive mesorectal lymph nodes (N+). In lesions of Stage ypT0 cancer 12.5% patients were node positive, in Stage Tis and T1 tumours there was no case of node positivity, but in Stage T2 and Stage T3 cancers the incidence of node positivity was 27.5% and 64%.
  
  
  CONCLUSIONS
  The study demonstrated that, even for small tumours involving only one rectal quadrant, the risk of lymph nodal involvement was about 25%. Had the patients undergone local excision the treatment would have been incomplete.
authors: Department of Surgery, Faculty of Medicine in Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: A
authors: A
authors: Ferko
authors: Department of Surgery, Faculty of Medicine in Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: J
authors: J
authors: Orhalmi
authors: Department of Surgery, Faculty of Medicine in Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: T
authors: T
authors: Dusek
authors: Department of Surgery, Faculty of Medicine in Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: M
authors: M
authors: Chobola
authors: Fingerland Department of Pathology, Faculty of Medicine Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: E
authors: E
authors: Hovorkova
authors: Fingerland Department of Pathology, Faculty of Medicine Hradec Králové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors: D
authors: D
authors: Hadzi Nikolov
authors: Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic.
authors: J
authors: J
authors: Dolejs
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Rectal carcinoma; local excision; lymph nodal involvement; neoadjuvant chemoradiotherapy; total mesorectal excision