Surgical treatment of rectal cancer

Surgical treatment of rectal cancer:

The surgical approach to rectal cancer depends on the location of the rectal cancer swelling. There are two systems within the rectal wall: the submucosal lymphatic plexus and the myenteric lymphatic plexus. It is rare for cancer cells to metastasize in the lymphatic system of the intestinal wall. Once cancer cells penetrate the intestinal wall, they will spread to the lymphatic system outside the intestinal wall.

1. Generally speaking, it first involves the para-intestinal lymph nodes of the same level or slightly higher cancer, then gradually involves the intermediate lymph node group with the superior hemorrhoidal artery, and finally involves the lymph node group beside the inferior mesenteric artery. The above lymph node metastasis is the most common way of metastasis of rectal cancer.

2. If the cancer is located in the lower rectum, the cancer cells can also invade the obturator lymph nodes laterally along the lymphatic vessels on the surface of the levator anus muscle and pelvic wall fascia, or flow to the internal iliac lymph nodes along the middle hemorrhoidal artery. Sometimes the cancer cells can also go down through the levator anus muscle and drain along the inferior hemorrhoidal artery to the sciatic rectal lymph nodes and inguinal lymph nodes. Since the lymphatic metastasis direction of cancer in the upper rectum is almost uniform, surgery can cure it by removing the lymphatic tissue near the cancer and above the plane.

3. Although lymphatic metastasis of subrectal cancer is mainly upward, it is still possible to metastasize laterally to the internal iliac lymph nodes and obturator lymph nodes. Radical surgery includes the tissues around the rectum and anal canal and the anal levator muscles, so the anal sphincter cannot be preserved.