| Objective: To research the rule of lymph nodes metastases,distal intramural and mesorectal spread to the primary tumor of rectal carcinoma, and to provide evidence for rectal carcinoma operations.Methods: Specimens of sixty patients with rectal carcinoma who had been operated from November, 2001 to October, 2002 were collected. The specimens resected en bloc were extended to the original size and shape, handled by the fat clearing method. Lymph nodes and isolated mesenteric cancer nodes extracted using transillumination and histologically examined for metastases; then a lymph nodes and isolated mesenteric cancer nodes map was produced that included the site of the primary lesion, the vascular distribution, and the sites of extracted nodes. The distal mural at 5mm interval was cut continuously into 5μm sections and examinedmicroscopically. Analysed the significance of the fat clearing method in detection of the lymph nodes.Results: 1. The fat clearing method was more accurate than the conventional manual method for the detection of lymph nodes in rectal carcinoma. 2. The metastatic incidence of lymph nodes (nodes with metastases divided by the total of examined nodes) was correlated with age, gross type, histological type and infiltrative depth, but not with sex, site and size of the tumor. The metastatic rate of lymph nodes (patients with metastases divided by the total of patients) was correlated with histological type, but not with sex, age, site of the tumor, size of the tumor, gross type and infiltrative depth. The metastatic rate of isolated mesenteric cancer nodes (patients with metastases divided by the total of patients) was correlated with infiltrative depth, lymph nodes metastases and Dukes stage, but not with sex, age, site of the tumor, size of the tumor, gross type and histological type. 3. The proportion of both total number and metastases of small lymph nodes was large and noticeable. 78% of the 2566 lymph nodes and 40.1% of the 202 metastatic node was ≤5mm in diamerer, 59.0% of the 56 isolated mesenteric cancer nodes was ≤5mm in diameter. 4. The tendency of lymph nodes metastases in rectal carcinoma was firstly to the pararectal lymph nodes group, thence to the superior hemorrhoidal artery lymph nodes group, finaly to the root of inferior mesenteric arterylymph nodes group. 5. Tumor spread to the distal intramural was observed in 11 of 60 patients (18.3%). The range of tumor spread to the distal intramural was within 1.5 cm. The tumor spread to the distal intramural was correlated with gross type, histological type and infiltrative depth, but not with sex, age, site of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. The spread routes to distal mesorctum mainly contained lymph nodes and isolated mesenteric cancer nodes metastases. The metastatic rate of total, lymph nodes and isolated mesenteric cancer nodes was 13.3% (8/60), 10.0% (6/60) and 6.7% (4/60). The range of spread to the distal mesorectum was within 4.5 cm. Lymph nodes spread to the distal mesorectum was correlated with gross type, histological type and infiltrative depth, but not with sex, age, site and size of the tumor. Isolated mesenteric cancer nodes to the distal mesorectum was correlated with site of the tumor and Dukes stage, but not with sex, age, size of the tumor, gross type, histological type, infiltrative depth and lymph nodes metastases. Conclusions: 1. The undetection of lymph nodes may lead to degradation of Dukes stage in rectal carcinoma. The fat clearing method was a accurate and true means of detection of lymph nodes, which can detect nodes smaller than 5 mm effectually. 2. In the radical surgery of rectal carcinoma, the range of distal mesorectal and mural excision shouldexceed 4.5 cm and 1.5 cm to the rectal tumor , and ensure visceral pelvic fascia intact. High ligation of the inferior mesenteric artery root and clean of lymph nodes is necessary. It sould be noted to the patients with poor cell differentiation, deep infiltration and advance...
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