[Intra-operative local tumor cell dissemination in rectal carcinoma surgery: effect of operation principles and neoadjuvant therapy].
BACKGROUND
The influence of surgical principles and neoadjuvant therapy on the frequency of local tumor cell dissemination (LTCD) in rectal carcinoma surgery and its consequences for local recurrence and survival rates were analyzed.


METHODS
Data from the Erlangen registry for colorectal carcinomas (ERCRC) from 1969-2008 were compared with data from the literature published in 1980-2008.


RESULTS
LTCD was observed in 6.7% in the ERCRC (n=2764) and a frequency of 6.9% was reported in in the literature (n=13,395). In the course of time and especially since the introduction of total mesorectal excision (TME) surgery, the incidence of LTCD has significantly decreased. Neoadjuvant treatment did not influence the frequency of LTCD. Following LTCD the rate of local recurrence significantly increased and the 5 year survival rate significantly decreased. This also applied to patients with neoadjuvant therapy.


CONCLUSIONS
Even in the era of TME surgery attention must to be paid to avoidance of LTCD. It is obligatory to document the occurrence of LTCD and it must be taken into consideration in routine quality assurance. In cases of LTCD postoperative chemoradiation is indicated for patients without neoadjuvant irradiation.
Merkel
S
S
Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland. susanne.merkel@uk-erlangen.de
Hohenberger
W
W
Hermanek
P
P
D006801:Humans; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D009366:Neoplasm Seeding; D011379:Prognosis; D011785:Quality Assurance, Health Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012042:Registries; D015996:Survival Rate