title: Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer.
abstract: 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.
authors.affiliation: Colorectal Research Unit, North Hampshire Hospital, Basingstoke, United Kingdom.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Cecil
authors.forename: Rosemary
authors.initials: R
authors.lastname: Sexton
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Heald
mesh_terms: 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