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Macroscopic assessment of mesorectal excision in rectal cancer
Author(s) -
GarcíaGranero Eduardo,
Faiz Omar,
Muñoz Elena,
Flor Blas,
Navarro Samuel,
Faus Carmen,
GarcíaBotello Stephannie Anne,
Lledó Salvador,
Cervantes Andrés
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24387
Subject(s) - medicine , mesorectum , total mesorectal excision , colorectal cancer , odds ratio , abdominoperineal resection , univariate analysis , multivariate analysis , surgery , cancer , radiology
BACKGROUND: High quality of surgical technique and the use of descriptive measures to assess and report surgical proficiency have been shown to influence locoregional tumor control in patients with rectal cancer. In this study, the authors have aimed to audit the implementation of a macroscopic assessment of mesorectal excision (MAME) and to investigate factors that influenced surgical quality and disease recurrence. METHODS: All curative resections for rectal cancer were prospectively evaluated for MAME between 1998 and 2007. Mesorectal specimens were graded into 3 types: complete, nearly complete, and incomplete categories. Univariate and multivariate analyses identified independent risk factors for noncomplete mesorectum categories as well as local and overall tumor recurrence. RESULTS: Of 359 specimens, 294 (81.9%) underwent evaluation; 82.3% were “complete.” Abdominoperineal resection (APR) was the sole covariate associated with inadequate mesorectal excision (odds ratio [OR] = 2.7; P = .003). Independent predictors of local recurrence were circumferential resection margin (CRM) involvement (OR = 3.6; P = .027) and noncomplete mesorectum (OR = 4.4; P = .008). CRM+ (OR = 3.1; P = .004), poorly differentiated tumors (OR = 14.2; P = .010), nodal involvement (OR = 2.9; P = .010), and APR (OR = 2.9; P = .006) were independent risk factors for overall recurrence. In lower third tumors, noncomplete mesorectum occurred more frequently in APR compared with sphincter‐saving procedures (31.1% vs 18.8%; P = .088). CONCLUSIONS: This study demonstrates the value of auditing MAME. Good proficiency of mesorectal excision is associated with lower tumor recurrences after curative surgery, and is a morphological tool found to be useful in clinical practice. Cancer 2009. © 2009 American Cancer Society.