Anterior resection for rectal cancer with mesorectal excision: institutional review

This study aims to compare the operative results and oncological outcomes of patients with total mesorectal excision (TME) for mid and distal cancer and partial mesorectal excision (PME) for proximal cancer. Anterior resection has become the preferred treatment option for rectal cancer. TME with sharp dissection has been shown to be associated with a low local recurrence rate. Controversies still exist as to the need for TME in more proximal tumor. Resection of primary rectal and rectosigmoid cancer was performed in 298 patients from January 2003 to November 2010. These 298 patients (163 men and 135 women; median age, 67 years) underwent anterior resection. The curative resection was performed in 269 patients (90.3 %). TME was performed in 202 patients (67.8 %). Significantly longer median operating time, more blood loss, and a longer hospital stay were found in patients with TME. The overall operative mortality and morbidity rates were 1.8 % and 32.6 %, respectively, and there were no significant differences between those of TME and PME. Anastomotic leak occurred in 8.1 % and 1.3 % of patients with TME and PME, respectively (P < 0.001). Independent factors for a higher anastomotic leakage rate were TME, the malegender, the absence of stoma, and increased blood loss. The advanced stage of the disease and the performance of coloanal anastomosis were independent factors for increased local recurrence. By performing TME in patients with mid and distal rectal cancer, the local control and survival of these patients are similar to those of patients with proximal cancers where adequate clearance can be achieved by PME.