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Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997
R J Heald1, B J Moran, R D Ryall
1Colorectal Research Unit, The North Hampshire Hospital, Basingstoke, Hampshire, England.
Objective:
To examine the role of total mesorectal excision in the management of rectal cancer.
Design:
A prospective consecutive case series.
Setting:
A district hospital and referral center in Basingstoke, England.
Patients:
Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation.
Interventions:
Anterior resections (n = 465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal resections (n = 37), Hartmann resections (n = 10), local excisions (n = 4), and laparotomy only (n = 3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal resections, 38 with anterior resections, 3 with Hartmann resections, and 1 with laparotomy).
Main Outcome Measures:
Local recurrence and cancer-specific survival.
Results:
Cancer-specific survival of all surgically treated patients was 68% at 5 years and 66% at 10 years. The local recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence interval, 2%-14%) at 10 years. In 405 "curative" resections, the local recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence interval, 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years and 78% at 10 years. An analysis of histopathological risk factors for recurrence indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as variables in these results.
Conclusions:
Rectal cancer can be cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all stages and in 4 of 5 patients having curative resections. In future clinical trials of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal excision as the surgical procedure of choice.