Mesorectal pathologic assessment in two grades predicts accurately recurrence, positive circumferential margin, and correlates with survival.
OBJECTIVE
We aimed to determine the prognostic value of the mesorectum quality assessed in a two-grade system compared with a classic system.


METHODS
Consecutive patients undergoing surgery for rectal cancer were included (n = 103). Mesorectum was assessed into three grades (classic system: complete, nearly complete, incomplete) and compared with a two-grade system (adequate, inadequate).


RESULTS
Mesorectum was complete in 62 (60.25%) patients, nearly complete in 21, and incomplete in 20. Reassessment showed adequate mesorectum in 83 (80.5%) patients and inadequate in 20. A R0 resection was achieved in 90.4% of adequate mesorectum and in 65% of inadequate mesorectum (P = 0.006). Recurrence was present in 18% of adequate mesorectum patients as compared with 50% of inadequate mesorectum (P = 0.003). The classic system failed to accurately predict the 5-year survival rate between complete (78.9%) and nearly complete (86.2%) categories (P = 0.235); whereas a two grading system showed a 5-year survival rate of 80.8% for adequate versus 39.3% for inadequate (P = 0.034).


CONCLUSIONS
High recurrence occurred in inadecuate mesorectum patients and was correlated with R1/R2 resections, positive margins, and decreased survival. We propose a simplified classification of mesorectum that correlates with survival and overall recurrence.
Department of Gastrointestinal Pathology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Leonardo S
LS
Lino-Silva
Department of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Miguel A
MA
García-Gómez
Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
José M
JM
Aguilar-Romero
Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
Jorge A
JA
Domínguez-Rodríguez
Department of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Rosa A
RA
Salcedo-Hernández
Department of Gastrointestinal Pathology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Reynaldo
R
Loaeza-Belmont
Department of Translational Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Erika B
EB
Ruiz-García
Department of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Ángel
Á
Herrera-Gómez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
cancer; colorectal; mesorectum; total mesorectal excision