Is total mesorectal excision necessary for treatment of upper rectal cancer?

Abstract

Objective: To assess the impact of mesorectal excision for upper rectal cancer on long-term treatment results.Materials and methods. 227 patients with upper rectal cancer in the period between January 2004 and December 2014 were analyzed. The study included patients over 18 years of age with upper rectal cancer, stage T2-4N0-2M0. The patients were divided into 2 groups: partial mesorectal excision (PME) and total mesorectal excision (TME).Results. 226 (99.6 %) of 227 patients underwent surgical treatment. PME was performed in 199 (85.4 %) patients, TME in 27 (14.6 %) patients. TME was significantly more often performed in patients with preoperative treatment (р = 0.03). Operative time did not differ significantly between the two groups (TME - 186 minutes and PME - 168 minutes; р = 0.34). Postoperative complications were observed in 12.3 % of cases with no significant differences between the groups (TME - 14.3 %, PME - 12.1 %; р = 0.68). Anastomotic failure was noted in 7.1 % of cases, all in the PME group. Median follow-up was 57 months. The number of deaths was 29 (12.8 %), in the PME group - 27 (13.6 %), and in the TME group - 2 (7.4 %) (р = 0.61). Local recurrences developed in 4 (2.2 %) patients of the PME group and none in TME group. Distant metastases were diagnosed in 2 patients (8 %) of the TME group and 23 patients (12.1 %) of the PME group (р = 0.509). Overall 5-year survival in the TME group was 79.6 %, in the PME group - 86.3 % (р = 0.463), and 5-year disease-free survival was 79.3 % and 86 %, respectively (р = 0.521).Conclusion. Multivariate analysis showed that the volume of mesorectal excision did not affect the rate of disease recurrence and disease-free survival in both groups.