Abstract
Total mesorectal excision (TME) is considered standard of care for rectal cancer treatment. Failure to remove the mesorectal fat envelope entirely may explain part of observed local and distant recurrences. Several studies suggest quality of the mesorectum after TME surgery as determined by pathological evaluation may influence prognosis. We aimed to determine the prognostic value of the plane of surgery as well as factors influencing the likelihood of a high-quality specimen by reviewing the literature. A pooled meta-analysis of relevant outcome data was performed where appropriate. A muscularis propria resection plane was found to increase the risk of local recurrence (RR 2.72 [95 % CI 1.36 to 5.44]) and overall recurrence (RR 2.00 [95 % CI 1.17 to 3.42]) compared to an (intra)mesorectal plane. Plane of surgery is an important factor in rectal cancer treatment and the documentation by pathologists is essential for the improvement of TME quality and patient outcome.
Highlights
The development of total mesorectal excision (TME), introduced by Heald and Ryall in the early 1980s, is based on the notion that lateral mesorectal spread of small tumour foci, which are not removed in classic anterior resection, can lead to local recurrence after rectal cancer surgery [1, 2].S
In our study on low rectal cancer we reported the surgical quality of abdominoperineal resection (APR) specimens only, and this may explain the high percentage of muscularis propria resection planes [14]
We performed a meta-analysis of published data relating plane of surgery achieved after TME to patient outcome
Summary
The development of total mesorectal excision (TME), introduced by Heald and Ryall in the early 1980s, is based on the notion that lateral mesorectal spread of small tumour foci, which are not removed in classic anterior resection, can lead to local recurrence after rectal cancer surgery [1, 2]. Predicting local recurrence by acknowledging the importance of lateral tumor spread led to the introduction of the circumferential resection margin (CRM) This margin, which comprises the entire nonperitonealized circumference of the resection specimen, has a relatively short, distally located anterior aspect, whereas posteriorly it has a triangular shape and runs up to the start of the sigmoid mesocolon [7]. Curr Colorectal Cancer Rep (2012) 8:90–98 show considerable variation in population size, study design, and results, making it difficult to appreciate the relevance of studied variables It is the purpose of this article to critically review the current literature on the prognostic value of plane of surgery and the factors associated with achieving a satisfactory surgical specimen. A pooled metaanalysis of relevant outcome data will be performed where appropriate
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