Total mesorectal excision in the operative treatment of carcinoma of the rectum Journal Article
| Authors: | Enker, W. E.; Thaler, H. T.; Cranor, M. L.; Polyak, T. |
| Article Title: | Total mesorectal excision in the operative treatment of carcinoma of the rectum |
| Abstract: | BACKGROUND: Total mesorectal excision (TME) is reported to reduce local recurrence and improve survival rates in patients with carcinoma of the rectum. STUDY DESIGN: Two hundred forty-six consecutive patients with Dukes' B (T-3, N-0, M(0)) and C (T-any, N-1-2, M(0)) primary rectal carcinomas underwent operation according to the principle of TME. Kaplan-Meier estimates of survival and pelvic recurrence rates were calculated from a database of patients followed prospectively. RESULTS: The operative mortality rate was 0.8 percent (two of 246). The Kaplan-Meier five-year survival rate for patients with stages B and C was 74.2 percent; for patients with stage T-3, N-0, M(0), 86.7 percent; for patients with stage T-any, N-1-2, M(0), 64.0 percent; and for patients with substage T-3, N-1-2, M(0), 68.0 percent. Pelvic recurrences were observed in a total of 18 patients (7.3 percent) with or without metastases. In the 246 patients with Dukes' stages B and C, pelvic recurrence rates were 4.0 and 8.1 percent, respectively, in the presence or absence of distant metastases, and 3.0 and 5.8 percent, respectively, in the absence of distant spread. Statistically significant risk factors for pelvic recurrence were N-2 disease and perineural invasion. Adjuvant radiation therapy was of no statistical benefit in preventing local recurrences. CONCLUSIONS: Total mesorectal excision cures carcinoma of the rectum and provides excellent local control through resection of the entire unit of regional spread that is excised, intact and with negative circumferential margins. Total mesorectal excision is compatible with autonomic nerve preservation and with sphincter preservation. The current role of combined modality adjuvant therapy, which is standard therapy following conventional surgery, should be reconsidered in patients who have undergone resection in accordance with TME. |
| Keywords: | survival; adenocarcinoma; radiation-therapy; local recurrence; european-organization; adjuvant treatment; curative surgery; cancer eortc; sphincter-saving resection; abdomino-perineal resection |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 181 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 1995-10-01 |
| Start Page: | 335 |
| End Page: | 346 |
| Language: | English |
| ACCESSION: | WOS:A1995RY25800009 |
| PROVIDER: | wos |
| PUBMED: | 7551328 |
| Notes: | Article -- Source: Wos |
Citation Impact
Related MSK Work