The radicality of surgical resection in rectal cancer.
Analysis of factors associated with incomplete mesorectal excision

Czech version

Authors: A. Ferko ¹; J. Örhalmi ¹; D. H. Nikolov ²; E. Hovorková ²; M. Chobola ¹; M. Vošmik ³; E. Čermáková ⁴
Authors‘ workplace: Chirurgická klinika, LF a FN Hradec Králové, přednosta: Prof. MUDr. A. Ferko, CSc. ¹; Fingerlandův ústav patologie, LF a FN Hradec Králové, přednosta: Prof. MUDr. A. Ryška, PhD. ²; Klinika onkologie a radioterapie, LF a FN Hradec Králové, přednosta: Prof. MUDr. J. Petera, PhD. ³; Oddělení výpočetní techniky, LF Hradec Králové, vedoucí: Ing. J. Šuplák ⁴
Published in: Rozhl. Chir., 2013, roč. 92, č. 6, s. 304-310.
Category: Original articles

Podpořeno MZ ČR – RVO (FNHK, 00179906)

Overview

Introduction:
Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision.

Material and methods:
Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients’ data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery.

Results:
168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmann’s procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) – 11 out of 27 (41%), and Hartmann’s operation – 6 out of 10 (60%).

Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors associated with incomplete mesorectal excision. It was the location of the tumour in the distal third of the rectum and the (y)pT stage of the tumour.

Conclusion:
Distal rectum tumor location and higher (y)pT are associated with a higher risk of incomplete mesorectal excision with worse patient prognosis.

Key words:
total mesorectal excision – circumferential resection margin – rectal carcinoma – colorectal carcinoma

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