Oncologic Outcomes and Safety after Tumor-specific Mesorectal Excision for Resectable Rectal Cancer: A Single Institution's Experience with 1,276 Patients with Rectal Cancer.
10.3393/jksc.2008.24.2.121
- Author:
Nam Kyu KIM
1
;
Byung Soh MIN
;
Jin Soo KIM
;
Hyuk HUR
;
Kang Young LEE
;
Seung Kook SOHN
;
Chang Hwan CHO
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Tumor specific mesorectal excision;
Oncologic outcomes;
Safety
- MeSH:
Anal Canal;
Colorectal Neoplasms;
Follow-Up Studies;
Humans;
Multivariate Analysis;
Postoperative Complications;
Prospective Studies;
Rectal Neoplasms;
Recurrence;
Retrospective Studies;
Risk Factors;
Survival Rate
- From:Journal of the Korean Society of Coloproctology
2008;24(2):121-133
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The purpose of this work was to review the oncologic outcomes and the operative safety of a tumor- specific mesorectal excision (TSME) for resectable rectal cancer. The risk factors for recurrence and survival were analyzed, and the changes in the sphincter-preserving rate with time were analyzed. METHODS: A total of 1,276 patients with rectal cancer who underwent curative surgery between 1989 and 2003 were analyzed retrospectively. The enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. RESULTS: The pathologic stages were stage I in 330 (25.9%), II in 403 (31.6%), and III in 543 (42.6%). Postoperative complications developed in 263 patients (20.6%). The rates of anal sphincter preservation were 32.6% between 1989 and 1993, 56.8% between 1994 and 1998, and 69.4 % between 1999 and 2003. With a mean follow-up of 69.4 months, the overall local recurrence (LR) rate was 5.4%. The 5-year LR rates were 3.8% in stage I, 4.7% in stage II, and 8.4% in stage III (P=0.016). A multivariate analysis revealed that the risk factors affecting LR were pN (0.005) and preoperatively increased serum CEA (P=0.008). The 5-year cancer-specific survival rates were 93.8% in stage I, 84.5% in stage II, and 64.5% in stage III (P=0.021). A multivariate analysis revealed that the factors affecting cancer-specific survival were pN (P=0.012) and circumferential resection margin (P<0.001). CONCLUSIONS: TSME for resectable rectal cancer showed acceptable operative morbidity and excellent oncologic outcomes. The trend toward sphincter preservation was obvious, and the shortening of the distal resection margin without deteriorating the oncologic outcomes was one of the major enabling factors.
