Total mesorectal excision quality as a predictor of overall survival in rectal cancer: A retrospective cohort study

Achieving complete total mesorectal excision (TME) is considered an important indicator of surgical quality in rectal cancer surgery. However, the impact of TME quality on overall survival (OS) remains controversial. This study aimed to evaluate the association between TME quality and OS in patients undergoing rectal cancer surgery.

A retrospective analysis was conducted on 171 patients who underwent elective low anterior resection or abdominoperineal resection for rectal cancer between 2021 and 2022. OS was compared between patients with incomplete TME and those with near-complete or complete TME. In addition, clinical and pathological factors associated with TME quality were assessed.

Incomplete TME was independently associated with worse OS [hazard ratio (HR)=2.53, 95% confidence interval (CI) 1.15-5.59, p=0.021], while undergoing a Hartmann procedure showed the strongest negative impact on OS (HR=4.60, 95% CI 2.04-10.38, p<0.001). At 36 months, OS was 86.3% in the near-complete/complete TME group versus 68.3% in the incomplete group (log-rank p=0.008). Factors associated with incomplete TME included lower preoperative albumin levels, larger tumor size, previous abdominal surgery, tumors located closer to the anal verge, lymphovascular invasion, and positive circumferential resection margins.

Incomplete TME was associated with significantly worse OS in patients undergoing rectal cancer surgery. These findings highlight the importance of achieving optimal TME quality. Larger prospective studies are warranted to validate these results.