Pre Operative Staging and Patient Selection

The staging system adopted in the present chapter refers to TNM classification [1]. Stage T1 has been

Fig. 1. Depth of invasion into the submucosa: sml, upper-third; sm2, middle-third; sm3, lower-third (With permission from [8])

divided into three subgroups according to the Japanese classification (Fig. l).

Only NO tumours are amenable to undergo LE of low-lying rectal cancer because by definition satellite lymph nodes are left behind [2]. Considering this aspect, a correct and reliable pre-operative staging is of dramatic importance [3]. Besides, should LE fail, salvage rectal resection remains the only chance, although prognosis remains poor in these cases.

In order to assess nodal involvement, the following predictive factors have been analysed: tumour depth (T), age, lymphovascular invasion, unfavourable histology, grading, tumour morphology and size.

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