Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and the prevention of pelvic recurrence

Abstract EN

Background : Total mesorectal excision (TME) has been reported to reduce pelvic recurrence and improve survival rates in patients with rectal carcinoma.

Methods : Twenty patients were admitted with curative intent to surgery with a mean foiiovv-up of 36 months.

Low anterior resection and total mesorectal excision were performed in all cases, regardless of the location of the rectal cancer.

A straight mechanical colorectal anastomosis was performed on a rectal stump, never exceeding 5 cm.

Mesorectum and open rectum were studied by serial transverse section at 5-mm intervals.

A search for depth of penetration and distal intramural extension of the tumor was made.

Lymph nodes were detected by clearing method, and nodal metastases (NM) and nonnodal metastases (NNM) were recorded proximally or at the level of the tumor.

Results : There was no postoperative mortality.

Clinical and radiological leaks occurred in 2 cases.

Mean disease-free survival was 30.7 months.

Pelvic recurrence occurred in 2 patients.

Involvement of the mesorectum by NM and NNM was detected in 6 and 8 patients respectively.

Within these patients, NM and NNM were found to be distal to the tumor in 33 % and 50 % of cases respectively.

Conclusion : Microscopic spread to the distal mesorectum may exceed the intramural extension of rectal cancer.

Failure to perform total mesorectal excision would leave a potentially residual disease in the distal mesorectum.

predisposing to pelvic recurrence.