Colorectal Cancer: Open Access

Tumor Location may Affect Total Mesorectal Excision Quality

Purpose: Total mesorectal excision (TME) is standard of care for patients with resectable rectal cancer. Post-operatively, specimens are graded as complete, nearly complete, or incomplete. It is known that incomplete mesorectal excisions are associated with increased local recurrence. This study looks at factors which may predict incomplete resections.
Methods: This retrospective medical record review looked at patients who underwent planned total mesorectal excision for rectal cancer from January 2012 to January 2015. Data was collected for the following variables: tumor height, tumor location, history of radiation therapy, history of prior pelvic surgery, history of neoadjuvant therapy, laparoscopic or open surgery. Patients were compared based on total mesorectal excision quality. Statistical analysis was done with Fisher’s exact tests and ANOVAs.
Results: 57 patient charts were reviewed and one patient was excluded. Out of this 56 patient cohort, 89% of specimens were complete, 5% were near complete and 5% were incomplete. Tumor location was the only variable which was significantly different among the three groups (p=0.002). Incomplete specimens came from tumors that were posterior (67%) and lateral (33%). Near complete specimens came from tumors that were anterior (33%) and lateral (67%). Out of 31 patients with circumferential tumors, 100% had complete TME’s.
Conclusions: Tumor location may affect TME quality. In this present study, circumferential tumors were associated with a complete TME whereas other tumor locations presented a risk for nearly complete or incomplete TME. Care should be taken during the dissection and the experienced surgeon should be involved in the surgery of tumors that are not circumferential.

Author(s):

Marissa A Mendez, Rebecca Wilcox, Peter W Callas and Peter Cataldo

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