Mesorectal pathologic assessment in two grades predicts accurately recurrence, positive circumferential margin, and correlates with survival

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.