대한대장항문학회

The locoregional recurrences after resection of the rectal cancer are known to be as<br>high as 10% to 32%, and large part of them due to lymph nodes metastases. Though<br>aortoiliac lymph nodes dissection might lessen local recurrences, the functional<br>preservation of pelvic autonomic nerves is also important as well as curative resection.<br>For the adequate curative resection of the rectal cancer, anatomical and histopathological<br>findings of rectal lymph nodes should coincide with few errors between computed<br>tomography(CT) and surgery. The existing classification of the rectal lymph nodes<br>include many problems such as duplication, difference of excised lymph nodes, and poor<br>correlation between CT and surgery. 6 groups of rectal lymph nodes were<br>divided<br>considering the location of tumor and lymphatic drainage in this new grouping. Group I<br>was separated from group 3 by the transverse line connecting both common iliad<br>bifurcations. Group 2 including the lymph nodes between internal and external iliad<br>nodes located just lateral to group 1, whereas group 4 located lateral to group 3<br>including common iliac nodes. The inferior mesenteric lymph nodes were designated as<br>group 5, and group 6 contained the paraaortic and inguinal nodes. 21 patients of rectal<br>cancers performing curative resection with pelvic autonomic preservation<br>were<br>prospectively allocated to this new grouping. Preoperative CT finding of lymph nodes<br>were evaluated during operation, and confirmed finally by histopathology. The mean<br>excised lymph nodes were 23 ± 6.6(15∼45), and the number decreased from group 1 to<br>group 5. The sensitivity of CT and surgery was lowest in group 2 and, 3 whereas the<br>specificity in group 1. The correspondence rate among CT, surgery, and histopathology<br>averages 79.7%(57.1% ∼ 100%). Group 2 of low sensitivity and group 5 of low accuracy<br>especially need accurate examination and excision during operation for their exclusion in<br>the formal resection of rectal cancer.<br>