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Related Experiment Videos

'Close shave' in anterior resection.

N D Karanjia1, D J Schache, W R North

  • 1Basingstoke District Hospital, Hampshire, UK.

The British Journal of Surgery
|May 1, 1990
PubMed
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Total mesorectal excision with distal rectal lavage allows for reduced resection margins in rectal cancer surgery. This technique does not increase local recurrence or negatively impact patient survival rates.

Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Rectal Cancer Management

Background:

  • Anterior resection is a key surgical procedure for rectal cancer.
  • Total mesorectal excision (TME) is the standard for rectal cancer surgery.
  • The impact of resection margin size on outcomes requires further clarification.

Purpose of the Study:

  • To evaluate the oncological outcomes of anterior resections for rectal cancer with varying resection margins.
  • To determine if a reduced resection margin compromises survival or increases local recurrence when TME and rectal lavage are employed.

Main Methods:

  • Retrospective analysis of 192 anterior resections for rectal cancer performed by a single surgeon over 10 years.
  • All procedures included TME and distal rectal lavage.

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  • Patients were categorized based on resection margin: >1 cm vs. ≤1 cm.
  • Outcomes assessed included curative resection rates, local recurrence, and distant recurrence.

    • Main Results:

    • 169 procedures (88%) included TME; all included rectal lavage.
    • 152 resections (79%) were curative.
    • 110 cases had margins >1 cm; 42 had margins ≤1 cm.
    • The group with margins ≤1 cm had no local recurrences (95% CI: 0-5.9%), while the >1 cm group had 3.6% local recurrence (95% CI: 0.8-7.4%).
    • No significant differences in local or distant recurrence rates were observed between the two margin groups (P=0.2).

    Conclusions:

    • Reduced resection margins in anterior resection for rectal cancer are safe when combined with meticulous TME and rectal lavage.
    • This approach does not appear to increase local recurrence rates or compromise overall survival.
    • Optimizing surgical technique, including TME and lavage, may allow for less extensive resection margins without adverse oncological consequences.