Lymphatic Drainage from the Rectum as Demonstrated by Double Isotope Method

Abstract

Lymphatic drainage from the rectum was studied in 13 cases by the double isotope transport method using ^99mTc-sulfur colloid and ¹¹¹In-colloid, following their submucosal injection into the rectum on the day before operation. Surgically dissected lymph nodes were classified into the following groups : Group 1 of the upward route, made up of the para-rectal nodes, superior rectal nodes and inferior mesenteric nodes ; Group 2 of the lateral pelvic route, consisting of the common iliac nodes, internal iliac nodes and external iliac nodes, and Group 3, comprising the para-aortic nodes. The nodes were individually assayed for the uptake of radioactivity by a well-type scintiration counter.
The study revealed that upward route from the rectum would be the main lymphatic stream : that the lateral pelvic route would be another important route for lymph node metastasis, and that there would be other routes to para-aortic nodes other than the upward lymphatic drainage : the inter-aorticovenous, preaortic and left lateroaortic nodes would also be the key to successful lymph node dissection.