Lymphovascular Invasion

The predictive value of lymphovascular invasion is still debated, although the majority of Authors consider this element as indicative of poorer outcome [10]. In a Japanese study on 182 patients lymphovascular invasion has been detected in 30% of T1sm1, though no one in this group showed lymph node invasion. The Authors concluded that the degree of infiltration through the rectal wall was by far a more reliable predictive factor than lymphovascular invasion [6]. Nivatvongs, reviewing 81 cases of degenerated colorectal polyps, showed vascular and lymphatic invasion in 37% and 20% of cases respectively, concluding that as far as it is carefully looked for, lymphovascular invasion seems a rather common finding in early rectal cancer [7]. On the other hand, Sengupta and Tjandra reporter a paper by Brodsky et al., which, although in a small group of 24 patients, showed that in T1 rectal cancer signs of lymphatic invasion imply a 33% of nodal involvement compared to 0% of N+ when no sign of lymphovascular invasion is present [2]. In a more recent study on 353 T1 rectal cancers, Nascimbeni et al. both in a univari-ate and a multivariate analysis concluded that lym-phovascular invasion is one of the three unique predictive factors of nodal involvement, with a high grade of statistical significance (p=0.005) [8].

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