Document Detail

Our experience of total mesorectal excision for rectal cancers.
MedLine Citation:
PMID:  20698213     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald et al. and has led both to a 5% de crease of local recurrences 5 and 10 years after the operation when compared with cases treated with conventional surgery, and to an increase of survival up to five years estimated in 80% of all cases. In Italy TME was firstly introduced for distal rectal carcinomas about 20 years ago, and has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer lasting method has an acceptable risk for the surgery of rectal tumours.
METHODOLOGY: We have compared two groups of patients operated for rectal carcinoma; the first, "historical control group" (no TME, including 46 patients) was treated with the standard surgery technique, while the second group (TME, 47 patients) underwent the total mesorectal excision technique. 14 of non TME patients belonged to Dukes stage A, 20 to stage B and 12 to C; whereas in the TME group 16 patients belonged to Dukes stage A, 23 to B and 8 to C. The patients of both groups undergone the exams of follow up (blood test, hepatic ultrasonography, abdominal CT, thorax Ro); the follow up pattern included periodic controls with a check-up every three and six months, from one to five years.
RESULTS: Postoperative complications in both groups do not show important differences in rates, although, the first group (no TME) had 11 cases with postoperative complications confronted with the 8 cases of the second group (TME). The complications taken into consideration were: anastomotic bleeding (3 patients no TME, 6% vs 1 patients TME, 2%), intestinal obstruction (1 patient no TME, 2% vs 1 patient TME, 2%), parietal infection (4 patients no TME, 9% vs 3 patients TME, 6%), anastomotic fistulae (2 patients no TME, 4% vs 2 patients TME, 4%), retention of urine and vesicular disorder (1 patient no TME, 2% vs 1 patient TME, 2%). Tumours closer to the anus have shown more complications compared with tumours at higher levels. As a matter of fact, 9 cases of no TME and TME patients with low located tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus; the rest 7 cases belonged to the middle rectum. A higher rate of local recurrences was noticed in the no TME group: 6 (13%) compared with the TME group: 3 (6%). Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 11% vs 4 patients TME, 8%), pulmonary metastasis (3, 6% of the no TME vs 2, 4% of the TME), anastomotic stenosis (4, 9% of the no TME vs 2, 4% of the TME), impotence (2, 4% of the no TME vs 1, 2% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C.
CONCLUSION: From our experience, we concluded that, in TME patients, complications are lower than in no TME patients; the site of the tumour affects the appearance of complications which are more frequently in distal localizations. An important result is the minor incidence of local recurrences after TME, which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumour.
Pasquale Petronella; Petronella Pasquale; Marco Scorzelli; Scorzelli Marco; Amelia Manganiello; Manganiello Amelia; Luigi Nunziata; Nunziata Luigi; Marco Ferretti; Ferretti Marco; Ferdinando Campitiello; Campitiello Ferdinando; Antonio Santoriello; Santoriello Antonio; Fulvio Freda; Freda Fulvio; Silvestro Canonico; Canonico Silvestro
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  57     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2010 May-Jun
Date Detail:
Created Date:  2010-08-11     Completed Date:  2010-09-07     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  482-6     Citation Subset:  IM    
Second University of the Study of Naples, School of Medicine, Department of Gerontology, Geriatry and Metabolic Diseases, U.O. of Geriatric Surgery, Piazza Miraglia, 5, 80138 Naples, Italy.
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MeSH Terms
Aged, 80 and over
Middle Aged
Neoplasm Recurrence, Local / prevention & control
Postoperative Complications / epidemiology
Rectal Neoplasms / pathology,  surgery*
Rectum / surgery*
Erratum In:
Hepatogastroenterology. 2011 Jan-Feb;58(105):264
Note: Pasquale, Petronella [corrected to Petronella, Pasquale]; Marco, Scorzelli [corrected to Scorzelli, Marco]; Amelia, Manganiello [corrected to Manganiello, Amelia]; Luigi, Nunziata [corrected to Nunziata, Luigi]; Marco, Ferretti [corrected to Ferretti, Marco]; Ferdinando, Campitiello [corrected to Campitiello, Ferdinando]; Antonio, Santoriello [corrected to Santoriello, Antonio]; Fulvio, Freda [corrected to Freda, Fulvio]; Silvestro, Canonico [corrected to Canonico, Silvestro]

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