title: Partial Mesorectal Excision for Rectal Adenocarcinoma: Morbidity and Oncological Outcome.
abstract: BACKGROUND
  The surgical approach for the treatment of tumors of the upper third of the rectum remains controversial. Several publications have shown that partial excision of the mesorectum (PME) with division of the mesorectum and rectum 5 cm below the tumor could be a reasonable approach although total mesorectal excision (TME) is still considered the gold standard for all rectal cancers in many studies. We aimed to assess the specifics risks of anterior resection with PME and colorectal anastomosis (CRA) in rectal cancer.
  
  
  METHODS
  Files of all of the patients who underwent a PME between 2000 and 2011 were reviewed in consecutive order. Complications that occurred within 3 months after surgery, oncological outcome, local and distant recurrences, and survival were assessed.
  
  
  RESULTS
  One hundred seventy-two patients had a PME with CRA of whom 49 (28.5%) had a dysfunctional stoma. Grade III to IV complications occurred in 18 (10.5%) patients and 2 (1.2%) died. Thirteen (7.6%) developed an anastomotic leakage, and 5 (2.9%) resulted with a permanent stoma. Mean follow-up was 151 months (range, 0-151 months). The 5-year local recurrence rate was 5.3%. The 5-year overall and disease-free survival assessed in the 147 patients without synchronous metastasis were 93.2% and 79.7%, respectively.
  
  
  CONCLUSIONS
  Partial excision of the mesorectum can be performed safely, in 1 stage in many patients, with a low risk of definitive stoma. The local recurrence and the survival rates that we observed indicate that the prognosis is not altered compared with TME. Therefore, PME can be recommended in the treatment of upper and some mid rectal tumors.
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Kanso
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France. Electronic address: jeremie.lefevre@sat.aphp.fr.
authors.forename: Jeremie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Department of Pathology, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Svrcek
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Najim
authors.initials: N
authors.lastname: Chafai
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Parc
authors.affiliation: Department of Digestive Surgery, Hospital Saint-Antoine AP-HP, University Paris VI (Pierre and Marie Curie), Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anastomotic leakage; Colorectal anastomosis; Mesorectum; Postoperative complications; Rectal cancer