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Local recurrence after mesorectal excision for rectal cancer
A Nesbakken1, K Nygaard, O Westerheim
1Department of Surgery, Aker Hospital, Oslo, Norway. Arild.Nesbakken@aker-sykehus.nu
Summary
Mesorectal excision (ME) significantly reduces local recurrence (LR) rates in rectal cancer patients compared to conventional surgery (CS). Partial ME is effective for upper rectal cancer, showing low LR rates.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Optimal surgical treatment for rectal cancer remains a subject of debate.
- Local recurrence (LR) is a critical outcome following rectal cancer surgery.
Purpose of the Study:
- To compare local recurrence (LR) rates between mesorectal excision (ME) and conventional surgery (CS) for rectal cancer.
- To evaluate the efficacy of partial ME (PME) in upper rectal cancer.
Main Methods:
- Retrospective comparison of rectal cancer patients undergoing ME (1993-1999) versus CS (1983-1992).
- Analysis included 161 patients in the ME group and 217 in the CS group.
- Five-year actuarial LR rates and survival were estimated using Kaplan-Meier method and Cox regression analysis.
Main Results:
- Total LR rate was significantly lower after ME (9% actuarial) compared to CS (24% actuarial) (P=0.02).
- ME demonstrated a 0.40 hazard ratio for LR compared to CS (P=0.02).
- Isolated LR rates were 2% for ME and 8% for CS. PME showed a 6% total LR rate with no isolated LRs.
Conclusions:
- Standardized mesorectal excision (ME) technique significantly reduces local recurrence rates in rectal cancer.
- Partial ME (PME) is an adequate procedure for upper rectal cancer, associated with low LR rates.