Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands.
BACKGROUND
Local control and survival following surgical treatment of rectal cancer have been improved by the introduction of total mesorectal excision (TME). The aim of this study was to determine the nationwide impact of the introduction and training of TME on recurrence and survival in rectal cancer.


METHODS
Short- and long-term outcomes of a recently published trial of rectal cancer surgery (TME trial) were compared with results from an older trial (cancer recurrence and blood transfusion (CRAB) trial), in which conventional surgery was performed without quality control. Only patients who were operated on with curative intent and who did not receive neoadjuvant radiotherapy were studied. Differences in clinicopathological characteristics were corrected for by multivariate analysis. To ensure valid comparisons, only events that occurred within 2 years of operation were analysed with regard to long-term outcome.


RESULTS
In the univariate analysis, a higher clinical anastomotic leak rate was found in patients following low anterior resection in the TME trial (P = 0.046), but this association was not significant in the multivariate analysis. The local recurrence rate decreased from 16 per cent in the CRAB trial to 9 per cent in the TME trial, and type of operation (conventional (CRAB trial) versus TME (TME trial)) was an independent predictor of local recurrence (P = 0.002). Type of operation was also an independent predictor of overall survival (P = 0.019); there was a higher survival rate in the TME trial.


CONCLUSIONS
The introduction and training of TME has led to improved long-term outcome of patients with rectal cancer in the Netherlands.
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
E
E
Kapiteijn
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H
Putter
C J H
CJ
van de Velde
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D003107:Colorectal Surgery / Q000193:education* / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality / Q000601:surgery; D009426:Netherlands; D011300:Preoperative Care / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D012044:Regression Analysis; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome