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International Journal of Surgical Oncology
Volume 2012, Article ID 438450, 8 pages
Review Article

Analysis of Risk Factors for Lymph Nodal Involvement in Early Stages of Rectal Cancer: When Can Local Excision Be Considered an Appropriate Treatment? Systematic Review and Meta-Analysis of the Literature

11st Division of General Surgery, S. Chiara Hospital, 38122 Trento, Italy
2Division of Medical Oncology and Palliative Medicine, Policlinic G. B. Rossi, 37134 Verona, Italy
3Department of Health, APSS, 38122 Trento, Italy
4Department of Obsterics and Gynecology, Policlinic G. B. Rossi, 37134 Verona, Italy

Received 15 March 2012; Revised 15 April 2012; Accepted 17 April 2012

Academic Editor: Manousos-Georgios Pramateftakis

Copyright © 2012 Alessandro Carrara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Over the past ten years oncological outcomes achieved by local excision techniques (LETs) as the sole treatment for early stages of rectal cancer (ESRC) have been often disappointing. The reasons for these poor results lie mostly in the high risk of the disease's diffusion to local-regional lymph nodes even in ESRC. Aims. This study aims to find the correct indications for LET in ESRC taking into consideration clinical-pathological features of tumours that may reduce the risk of lymph node metastasis to zero. Methods. Systematic literature review and meta-analysis of casistics of ESRC treated with total mesorectal excision with the aim of identifying risk factors for nodal involvement. Results. The risk of lymph node metastasis is higher in and tumours with lymphatic and/or vascular invasion. Other features which have not yet been sufficiently investigated include female gender, TSM stage >1, presence of tumour budding and/or perineural invasion. Conclusions. Results comparable to radical surgery can be achieved by LET only in patients with T1 N0 G1 tumours with low-risk histological features, whereas deeper or more aggressive tumours should be addressed by radical surgery (RS).