Local recurrence in patients treated for rectal cancer using total mesorectal excision or transection of mesorectum

Rectal cancer is a major health problem throughout the world, despite the great progress in the treatment and control of the disease. The aim of this study was to determine the effect of mesorectal excision type on local recurrence in patients operated on for rectal cancer within a 3- year period.

The clinical retrospective study was conducted at the Clinic for General Surgery at the Clinical Center in Niš, Serbia, and included 225 patients with rectal cancer. Postoperatively, the patients were observed 36 months. Total mesorectal excision (TME) method was used in 129 (57.33%) patients, and partial mesorectal excision (PME) in 96 (42.66%). There were 145 (64.44%) man and 80 (35.55%) women, average age 66.8 years.

In 58 (25.77%) of the patients cancer was localized in the proximal third of the rectum, in 99 (44%) in the medium third, in 68 (30.22%) it was 8 cm of the anocutaneous line. In 167 (74.22%) patients rectal cancer was in T3 stadium. TME was performed in all the patients with cancer in the distal third of the rectum and in 61.61% of the patients with cancer in the medium third of the rectum. PME was performed in all the patients with localized cancer in the proximal third and in 38.38% of the patients with cancer in the medium third of the rectum. Local recurrence occurred in 20 (8.88%) patients, 12 (9.30%) in the TME group and 8 (8.33%) in the PME group, which was not a statistically significant difference. In 75% of the cases, relapse occurred in the patients in T3 stage. Relapse occurred in 55% of the cases in the second year after the surgery. The median survival of all the patients amounted to 35 months. The total mortality of all respondents in a 3-year period amounted to 5.3%.

There were no statistically significant differences in the incidence of local recurrence and survival among patients who underwent TME and those underwent PME. The type of mesorectal excision does not affect the incidence of local recurrence in node-negative disease stages.