One hundred and thirty-two patients treated at our clinic for rectal carcinoma during the past 19 years were herein studied statistically. There were 76 men and 56 women members in the series, with a mean age of 54.5 years. Thirtytwo patients (24.2%) disclosed carcinomatous tendency in their family history. A total of 77 patients (58.3%) had anal involvement at some time in the past history. Chief complaints at the first examination were anal bleeding (63.6%), anal pain (13.6%), constipation (11.4%) and difficulties in bowel movement (7.6%). The duration of symptoms prior to admission was within 1 year (86.2%) in most of the patients presented here. The site of occurrence of the lesion was most frequently observed at the ampulla (64.3%) and the anterior wall of the rectum (33.3%) in the patients with radical operation. Pathological features were adenocarcinoma, carcinoma simplex, adenoacantoma, and squamous cell carcinoma in 76, 4, 1 and 4 patients respectively. Radical operation, mainly abdomino-perineal method, was performed in 100 patients, in whom only 2 patients underwent the second stage operation. Three-year, 5-year and 10-year-survival rate was 55.7%, 44.4% and 26.3% respectively.
The complete extirpation of regional lymph node is a most important concern in the curative resection of rectal cancer to prevent further dissemination. In order to disclose preoperatively the lymphatic spread of cancer of the rectum and anal canal, the direct lymphography has been performed on 58 cases in our clinic. The procedure of lymphography was performed by Kinmonth's method which had been presented on his paper. When the injection of the contrast media (38% Lipiodol ultra fluid) is finished, a first X-ray photograph is taken in which very fine lymphatic chanells will be demonstrated, so it is called as lymphangiography. A second X-ray photograph is to be taken after 24 hours, in which all the lymph nodes in the inguinal pelvic and para aortic regions, so it is usually called as lymphadenography. Both photographs are necessary to know the aspects of the lymphatic chanells and nodes. The injected contrast media reach to the inguinal nodes which are devided into two main groups-the superficial and the profound one. All proceed further to the external iliac group. This external iliac group is forked into three chains, namely the internal, middle and external one. But these chains communicate each other. The lymphatic drainages of the rectum will be devided into three groups on the basis of the course of their efferent vessels. These are grouped as superior, middle or lateral and inferior zone. But regions visualized by lymphography are limited and possibility of the metastasis into these region is little. By my investigation metastasis into the external iliac group was about 10% and into the inguinal group was about 8%. These frequencies are almost same as other reports. The main roentgenologic findings which suspect the metastasis of cancer to the nodes on lymphography are as follows : the peripheral or central filling defect of node, dilation of lymphatic channells and existence of bypathes. These findings were made sure by Softex photograph of the removed nodes. Fortunately, the majority of cases had no invasion in the regions which visualized by lymphography. It is said that the metastasis of the rectal cancer is mainly progressed through the superior zone. But this zone is not visualized by this procedure. However the lateral and inferior zone are adequately visualized, so it is emphasized that the prognosis, the degree of invasion and operative procedure should be decided by lymphography.