title: [Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study].
abstract: BACKGROUND
  Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed - total mesorectal excision (TME) - and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeons skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete. The aim of our study was to implement and standardize a new method of evaluation of the quality of the surgical procedure - TME - in rectal cancer treatment using an assessment of its circumferential margins (CRO) and completeness of the excision.
  
  
  METHODS
  The study consisted of two parts. The first, multi-centre retrospective phase with 288 patients analysed individual partial parameters of the diagnosis, operations and histological examinations of the rectal cancer. Critical points were identified and a unified follow-up protocol was prepared. In the second, prospective part of this study 600 patients were monitored parametrically focusing on the quality of the TME and its effect on the oncological treatment results.
  
  
  RESULTS
  The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7% based on preoperative diagnosis. The number of specimens missing an assessment of the mesorectal excision quality decreased from 52.9% in the retrospective part of to the study to 22.8% in the prospective part. The proportion of actually complete TMEs rose from 22.6% to 26.0%, and that of nearly complete TMEs from 10.1% to 24.0%.
  
  
  CONCLUSIONS
  The introduction of parametric monitoring into routine clinical practice improved the quality of pre-treatment and preoperative diagnosis, examination of the tissue specimen, and consequently improved quality of the surgical procedure was achieved.
  
  
  BACKGROUND
  rectal cancer TME - parametric monitoring - quality control.
authors: J
authors: J
authors: Hoch
authors: A
authors: A
authors: Ferko
authors: M
authors: M
authors: Bláha
authors: A
authors: A
authors: Ryška
authors: I
authors: I
authors: Čapov
authors: L
authors: L
authors: Dušek
authors: J
authors: J
authors: Feit
authors: M
authors: M
authors: Grega
authors: M
authors: M
authors: Hermanová
authors: E
authors: E
authors: Hovorková
authors: R
authors: R
authors: Chmelová
authors: Z
authors: Z
authors: Kala
authors: D
authors: D
authors: Klos
authors: R
authors: R
authors: Kodet
authors: D
authors: D
authors: Langer
authors: D
authors: D
authors: Hadži-Nikolov
authors: J
authors: J
authors: Örhalmi
authors: J
authors: J
authors: Páral
authors: M
authors: M
authors: Tichý
authors: I
authors: I
authors: Tučková
authors: M
authors: M
authors: Vjaclovský
authors: P
authors: P
authors: Vlček
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D008643:Mesentery / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011446:Prospective Studies; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden