Question 6

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A 51-year-old man is undergoing a screening colonoscopy during which a partially circumferential mass at the level of the upper rectal valve is found. On rigid proctoscopy, the mass is found to be located 11 cm from the anal verge. On pathologic evaluation, the lesion is identified as a moderately differentiated invasive adenocarcinoma. Pelvic magnetic resonance imaging (MRI) with and without contrast showed a T3N1 mass without extramural venous invasion (EMVI) and a radial margin of 7 mm. What is the immediate lymphatic drainage of the lesion?

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