الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fiftythree rectal cancer patients were randomly included in this study, they were thirty females and twentythree males. The data presented are neither statistical nor exact ratio frequency data,they are merely an analysis of the material treated in the study . The age was ranging from twenty to seventy two years with mean age of 48 years. most of the patients were presented with bleeding per rectum (66%) and the commonest site was the lower third rectum(45.3). The resected specimens were examined macroscopically, by routine microscopic examination and by immunostaining using anti CEA and anti cytokeratin antibodies for negative LN by routine H&E stain. Most of our patients had adenocarcinoma (73.6%) and were staged as stage C (71.7%). Total mesorectal excision is the standard operation for rectal cancer as the patient prognosis (survival and local control) largely depends on the surgical quality of rectal resection. Clearance technique was useful in obtaining the largest available number of lymph nodes than the conventional dissection(The mean number of LN were 9.11 LN & 3.45 LN respectively). also, it help in accurate staging of the patient(100% of the patients were accurately staged ) by harvesting both large number and smaller LNs where micrometastasis could be detected by immunostaining technique for negative lymph nodes by the ordinary haematoxylene & eosin which upstage 46% as stage C which may have its impact on prognosis and the need for adjuvant therapy.??? Endorectal ultrasound can provide us with the stage of the tumor for preoperative downstaging ,by adjuvent chemotherapy or radiotherapy, although it needs more evaluation(The sensitivity to detect metastatic LN was 65.8% ). Sentinel lymph node mapping is technically feasible in vivo in rectal cancer(75.5% of our patients had blue stained LN , and among this group ,the accuracy to detect metastatic LN was 77.4%). The real benefit of SLN mapping to the pathologist who can focus attention to one or four nodes and can do detailed examination by either ordinary or immunostaining instead of trying to harvest 2030 LN and performing serial sections of these nodes. However, when SLN mapping could not stain LN, clearance technique must be applied for accurate staging.