title: Total mesorectal excision for middle and lower rectal cancer: a single institution experience with 337 consecutive patients.
abstract: OBJECTIVE
  There have been reports on improved prognosis after TME for middle and lower rectal cancer. No prospective randomized studies have yet been performed. This is a large single institution series evaluating its own results of TME.
  
  
  METHODS
  This retrospective study analyses data of 337 patients with middle and lower rectal cancer, treated with either curative or palliative intention between 1990 and 1998.
  
  
  RESULTS
  Of all patients, 212 had lower rectal and 125 middle rectal carcinomas. The rate of rectal resections with TME was 96%. A total of 223 patients were treated by anterior rectal resection; 92 patients had to undergo abdomino-perineal resection. Ten patients were operated by a Hartmann resection. Postoperative morbidity was 35% with a leakage rate of 9%. Postoperative mortality was 4%. The rate of local recurrence was 8.6%. The 5-year survival rate after curative resection was 69.3%. The multivariate analysis outlined the tumor stage as independent prognostic factor.
  
  
  CONCLUSIONS
  In our experience, TME is feasible with acceptable postoperative morbidity and low mortality. The local recurrence rate can be decreased to lower than 10%. The almost 70% 5-year survival rate indicates a clear benefit for the patients. These findings recommend TME as standard procedure for middle and lower rectal cancer.
authors.affiliation: Department for Visceral and Transplantation Surgery, Hannover Medical School, Germany. piso.pompiliu@mh-hannover.de
authors.forename: Pompiliu
authors.initials: P
authors.lastname: Piso
authors.forename: Marc-Hendrik
authors.initials: MH
authors.lastname: Dahlke
authors.forename: Petrit
authors.initials: P
authors.lastname: Mirena
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt
authors.forename: Heiko
authors.initials: H
authors.lastname: Aselmann
authors.forename: Hans Juergen
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Rudolf
authors.initials: R
authors.lastname: Raab
authors.forename: Juergen
authors.initials: J
authors.lastname: Klempnauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D010502:Perineum / Q000601:surgery*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D015996:Survival Rate