Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center.
OBJECTIVE
The aim of this study was to review the results and long-term outcome after total mesorectal excision (TME) for adenocarcinoma of the rectum in an unselected population in a community teaching hospital.


METHODS
Between 1996 and 2003, 210 patients with rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathological reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed.


RESULTS
The mean age at diagnosis was 69 years (range 40-91 years). A total of 145 patients were treated by anterior rectal resection; 65 patients had to undergo an abdominoperineal resection (APR). Anastomotic leakage rate was 5%. Postoperative mortality was 3%. After a median follow-up of 3.6 years, the local recurrence-free rate in patients with microscopically complete resections was 91%. The 5-year overall survival rate was 58%. An increased serum carcinoembryonic antigen, an APR, positive lymph nodes, and an incomplete resection all significantly influenced the 5-year overall survival and local recurrence rate. In a multivariate analysis, age was the most important prognostic factor for overall survival.


CONCLUSIONS
Patients with rectal cancer can safely be treated with TME in a community teaching hospital and leads to a good overall survival and an excellent local control. In patients aged above 80, treatment-related mortality is an important competitive risk factor, which obscures the positive effect of modern rectal cancer treatment.
Ferenschild
Floris T J
FT
Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
Dawson
Imro
I
de Wilt
Johannes H W
JH
de Graaf
Eelco J R
EJ
Groenendijk
Richard P R
RP
Tetteroo
Geert W M
GW
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005240:Feasibility Studies; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data