Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer.
OBJECTIVE
Most series report lymph node involvement as the main predictor for local recurrence. The principal lymphatic drainage of the rectum is to nodes in the mesorectum and then nodes along the superior rectal and inferior mesenteric arteries. If total mesorectal excision provides adequate block dissection of the lymphatics of the rectum, good local control with low rates of local recurrence should be achieved even in node-positive disease.


METHODS
Prospective data on all rectal cancers have been collected since 1978; 170 patients with Dukes C rectal cancer have undergone anterior resection and total mesorectal excision. We did not perform any internal iliac node dissections. Follow-up data were analyzed for local recurrence and distant recurrence.


RESULTS
The local recurrence rate was 2 percent for Dukes A cases, 4 percent for Dukes B, and 7.5 percent for Dukes C ( P = 0.0127). The systemic recurrence rate was 8 percent for Dukes A, 18 percent for Dukes B, and 37 percent for Dukes C ( P = 0.0001).


CONCLUSIONS
If surgical priority is given to the difficult task of excision of the whole mesorectum, anterior resection with total mesorectal excision in node-positive rectal cancer, local recurrence rates of < 10 percent can be achieved.
Cecil
Thomas D
TD
Colorectal Research Unit, North Hampshire Hospital, Basingstoke, United Kingdom.
Sexton
Rosemary
R
Moran
Brendan J
BJ
Heald
Richard J
RJ
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008643:Mesentery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology