الفهرس 
Anatomy of the RectumOnly 14 pages are availabe for public view
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Abstract
The clinical and prognostic significance of lateral pelvic lymph node compartment remains controversial issue in surgical management of rectal cancer.
Western surgeons regard the mesorectum as the chief way of spread of rectal carcinoma, and its complete removal (Total mesorectal excision) is necessary and enough for radical surgical treatment and even consider patients with pelvic node metastases were a metastatic patient for neoadjuvant therapy first.
Japanese Surgeons consider that there are two pathways are involved in lymphatic drainage of the middle and lower rectum: superior lymphatic drainage along the inferior mesenteric artery and lateral lymphatic drainage along the internal iliac artery. The clinical importance of the lateral spread of lower rectal cancer was first demonstrated in the 1950s. Since then, lateral pelvic lymph node dissection (LPLD) has been performed for middle or lower rectal cancer in Japan and they are very careful to prevent extra-mesorectal spread to lateral pelvic lymph nodes, which may be found in up to 25% of rectal carcinomas.
Staging with magnetic resonance imaging provides an accurate assessment of tumour spread, infilteration ,mesorectal affection and lymphnode status and this good assessment affect the management plan for these patients and decision of preoperative chemoradiotherapy .
Our study conducted on 20 patients with middle and low rectal cancer with a mean age of 51.5 ± 9.55 years (range from 36 – 67).14 male patients and 6 female patients.
The most common presentation was bleeding per rectum (50%) followed by pain (30%) then contipation (20%) .
The most common pathological type among study group was adenocarcinoma (80%) and mucinous carcinoma (20%) .
By assessing of the patients with CT & MRI found that all 20 patient had positive pelvic LN preoperatively and post chemoradiotherapy . after excision histopathology revealed 13 patients (65%) with positive pelvic LN and 7 (35%) with negative LN, with significant P-value for, (The incidence of positive LPLN associated with positivity of pelvic L.Ns in MRI).
Postoperative histopathology of tumer invasion revealed 5 patients (25%) were T2 and 11 patients (55%) were T3 and 4 patients (20%) were T4 revealed increase positive pelvic LN in T3 nd T4 with significant P-value .
The patients submitted to Low anterior resection, another have submitted intersphincteric resection with anastomosis and covering ileostomy and abdominoperneal resection. A mean operative time of 146±15.12 minutes for patients with positive pelvic LN and 140±27.48 for patients with negative pelvic LN .
Postoperative complications were found in 3 patients (15%) complained of perineal wound dehiscence 2 patients (10%) and 1 patient (5%) with erectile dusfunction .