Total Mesenteric Excision in the Surgical Treatment of Rectal Cancer

摘要: Background Total mesorectal excision has been advocated in conjunction with low anterior or abdominoperineal resection as the optimal surgical treatment for rectal cancer. It involves removal of entire mesentery an intact unit and maximizes likelihood obtaining a negative circumferential margin. Objectives To prospectively validate efficacy total locoregional control, to identify perioperative factors influencing selection either sphincter sparing ablating procedure, independent that may influence long-term prognosis cancers. Settings Tertiary referral center. Patients Seventy-three consecutive patients cancer located within 10 cm anal verge were treated from 1984 1997 by senior author (F.M.). Sixty-five form basis our analysis after exclusion 7 who had their removed transanally 1 patient permanent diverting stoma only procedure. Results Twenty-six underwent procedure; 39 Operative mortality was 1.5%. Follow-up complete 64 (39±30 months; range, 3-126 months). Five-year actuarial survival rates 88% 34 stage I II adenocarcinoma 65% 22 III adenocarcinoma. The local recurrence rate 6.2% overall, but 3.1% potentially curable group (stages I-III). When did not receive adjuvant chemoradiation therapy considered (n=23), 8.3% overall 0% group. Tumor ( P =.04) vascular and/or lymphatic invasion =.002) statistically significant association survival. Circumferential lesions =.01) choice Conclusions This study confirms minimizing well-established prognostic value microinvasion. Moreover, it indicates lesions, distance verge, gross contiguous organs are type