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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 7/2004

01-07-2004 | Original Contribution

Total Mesorectal Excision Results in Low Local Recurrence Rates in Lymph Node-Positive Rectal Cancer

Authors: Thomas D. Cecil, F.R.C.S. (Gen Surg), Rosemary Sexton, B.Sc., Brendan J. Moran, M.Ch., F.R.C.S.I., Richard J. Heald, O.B.E., M.Chir., F.R.C.S.

Published in: Diseases of the Colon & Rectum | Issue 7/2004

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PURPOSE:

Most series report lymph node involvement as the main predictor for local recurrence. The principal lymphatic drainage of the rectum is to nodes in the mesorectum and then nodes along the superior rectal and inferior mesenteric arteries. If total mesorectal excision provides adequate block dissection of the lymphatics of the rectum, good local control with low rates of local recurrence should be achieved even in node-positive disease.

METHODS:

Prospective data on all rectal cancers have been collected since 1978; 170 patients with Dukes C rectal cancer have undergone anterior resection and total mesorectal excision. We did not perform any internal iliac node dissections. Follow-up data were analyzed for local recurrence and distant recurrence.

RESULTS:

The local recurrence rate was 2 percent for Dukes A cases, 4 percent for Dukes B, and 7.5 percent for Dukes C (P = 0.0127). The systemic recurrence rate was 8 percent for Dukes A, 18 percent for Dukes B, and 37 percent for Dukes C (P = 0.0001).

CONCLUSIONS:

If surgical priority is given to the difficult task of excision of the whole mesorectum, anterior resection with total mesorectal excision in node-positive rectal cancer, local recurrence rates of < 10 percent can be achieved.
Literature
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Rich, T, Gunderson, LL, Lew, R, Galdibini, JJ, Cohen, AM, Donaldson, G 1983Patterns of recurrence of rectal cancer after potentially curative surgeryCancer52131729
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Pilipshen, SJ, Heilweil, M, Quan, SH, Sternberg, SS, Enker, WE 1984Patterns of pelvic recurrence following definitive resections of rectal cancerCancer53135462
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Manfredi, S, Benhamiche, AM, Meny, B, Cheynel, N, Rat, P, Faivre, J 2001Population based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancerBr J Surg8812217
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Gunderson, LL, Sosin, H, Levitt, S 1985Extrapelvic colon—areas of failure in a reoperation series: implications for adjuvant therapyInt J Radiat Oncol Biol Phys1173141
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Bokey, EL, Ojerskog, B, Chapuis, PH, Dent, OF, Newland, RC, Sinclair, G 1999Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissectionBr J Surg86116470
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Heald, RJ, Moran, BJ, Ryall, RD, Sexton, R, MacFarlene, JK 1998Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997Arch Surg1338949
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Martling, AL, Holm, T, Rutqvist, LE, Moran, BJ, Heald, RJ, Cedemark, B 2000Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study GroupBasingstoke Bowel Cancer Research Project. Lancet356936
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Cecil T, Moran BJ, Heald RJ. Total mesorectal excision: a quality controlled approach to rectal cancer surgery. In: Bleiberg H, Kemeny N, Rougier P, Wilke H, eds. Colorectal cancer. A clinical guide to therapy. Martin Dunitz. 2002:185–92.
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Moran, BJ, Docherty, A, Finnis, D 1994Novel stapling technique to facilitate low anterior resection for rectal cancerBr J Surg811230
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McCall, JL, Cox, MR, Wattchow, DA 1995Analysis of local recurrence rates after surgery alone for rectal cancerInt J Colorectal Dis1012632
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Simunovic, M, Sexton, R, Rempel, E, Moran, BJ, Heald, RJ 2003Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapyBr J Surg909991003
Metadata
Title
Total Mesorectal Excision Results in Low Local Recurrence Rates in Lymph Node-Positive Rectal Cancer
Authors
Thomas D. Cecil, F.R.C.S. (Gen Surg)
Rosemary Sexton, B.Sc.
Brendan J. Moran, M.Ch., F.R.C.S.I.
Richard J. Heald, O.B.E., M.Chir., F.R.C.S.
Publication date
01-07-2004
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 7/2004
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-004-0086-6

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