title: Surgical outcomes after total mesorectal excision for rectal cancer.
abstract: OBJECTIVE
  This study reviewed the results of surgery for distal rectal cancer following the introduction of total mesorectal excision (TME) for rectal cancer.
  
  
  METHODS
  Two hundred sixty-four patients who had undergone elective curative surgical resection of rectal cancer within 12 cm of the anal verge were included. Comparisons were made between patients who had different surgical procedures.
  
  
  RESULTS
  The overall operative mortality rate was nil, and the morbidity 39.4%. With a mean follow-up of 34 months (range 5-105 months), local recurrence occurred in 21 of the patients. The 3- and 5-year actuarial local recurrence rates were 9% and 12%, respectively for the whole group. Abdominoperineal resection (APR) was necessary in 65 of 264 (24.6%) of the patients, with a very low local recurrence rate in this subgroup (5% at 3 years). On multivariate analysis, only stage was a significant prognosticator of overall survival (P = 0.012).
  
  
  CONCLUSIONS
  With the practice of TME, APR was still necessary in 25% of patients with rectal cancer within 12 cm of the anal verge. Type of surgery and tumor distance from the anal verge influenced local recurrence rates, but only initial tumor stage was associated with long-term survival.
authors.affiliation: Department of General Surgery, European Institute of Oncology, University of Milan, Milan, Italy. antonio.chiappa@unimi.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Zbar
authors.forename: Ugo
authors.initials: U
authors.lastname: Pace
authors.forename: Cristiano
authors.initials: C
authors.lastname: Crotti
authors.forename: Francesca
authors.initials: F
authors.lastname: Biella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pruneri
authors.forename: Davide
authors.initials: D
authors.lastname: Poldi
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012306:Risk; D017792:Surgical Stapling; D015996:Survival Rate; D016896:Treatment Outcome