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The Basingstoke Experience of Total
Mesorectal Excision, 1978-1997 |
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Objective: To examine the role of
total mesorectal excision in the management of rectal cancer.
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Design: A prospective consecutive
case series. |
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Setting: A district hospital and
referral center in Basingstoke, England. |
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Patients: Five hundred nineteen
surgical patients with adenocarcinoma of the rectum treated for cure or palliation. |
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Interventions: Anterior resections
(n=465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal
resections (n=37), Hartmann resections (n=10), local excisions (n=4), and laparotomy only
(n=3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal
resections, 38 with anterior resections, 3 with Hartman resections, and 1 with
laparotomy). |
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Main Outcome Measures: Local
recurrence and cancer-specific survival. |
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Results: Cancer-specific survival of
all surgically treated patients was 68% at 5 years and 66% at 10 years. The lowest
recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence
interval, 2%-14%) at 10 years. In 405 "curative" resections, the local
recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence
interval 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years
and 78% at 10 years. An analysis of histopathological risk factors for recurrence
indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as
variables in these results. |
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Conclusions: Rectal cancer can be
cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all
stages and in 4 of 5 patients having curative resections. In future clinical trials
of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal
excision as the surgical procedure of choice. |
