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Mesorectal pathologic assessment in two grades predicts accurately recurrence, positive circumferential margin, and correlates with survival
Author(s) -
LinoSilva Leonardo S.,
GarcíaGómez Miguel A.,
AguilarRomero José M.,
DomínguezRodríguez Jorge A.,
SalcedoHernández Rosa A.,
LoaezaBelmont Reynaldo,
RuizGarcía Erika B.,
HerreraGómez Ángel
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24076
Subject(s) - mesorectum , medicine , colorectal cancer , overall survival , grading (engineering) , surgery , cancer , total mesorectal excision , civil engineering , engineering
Background and Objectives We aimed to determine the prognostic value of the mesorectum quality assessed in a two‐grade system compared with a classic system. Methods Consecutive patients undergoing surgery for rectal cancer were included (n = 103). Mesorectum was assessed into three grades (classic system: complete, nearly complete, incomplete) and compared with a two‐grade system (adequate, inadequate). Results Mesorectum was complete in 62 (60.25%) patients, nearly complete in 21, and incomplete in 20. Reassessment showed adequate mesorectum in 83 (80.5%) patients and inadequate in 20. A R0 resection was achieved in 90.4% of adequate mesorectum and in 65% of inadequate mesorectum ( P = 0.006). Recurrence was present in 18% of adequate mesorectum patients as compared with 50% of inadequate mesorectum ( P = 0.003). The classic system failed to accurately predict the 5‐year survival rate between complete (78.9%) and nearly complete (86.2%) categories ( P = 0.235); whereas a two grading system showed a 5‐year survival rate of 80.8% for adequate versus 39.3% for inadequate ( P = 0.034). Conclusion High recurrence occurred in inadecuate mesorectum patients and was correlated with R1/R2 resections, positive margins, and decreased survival. We propose a simplified classification of mesorectum that correlates with survival and overall recurrence. J. Surg. Oncol. 2015;112:900–906 . © 2015 Wiley Periodicals, Inc.