Background Total mesorectal excision （TME） has increased the rate of sphincter-preservation （SP） for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower r...Background Total mesorectal excision （TME） has increased the rate of sphincter-preservation （SP） for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors. MethOds We reviewed retrospectively the medical records of 316 patients with lower rectal cancers, 1 to 5 cm from the anorectal line, who had surgical resections from August 1994 to November 2005. The 12-year span was divided into 2 periods： period Ⅰ（August 1994-December 1998） and period Ⅱ （January 1999-November 2005）, based on the date （January 1999） when standard total mesorectal excision （TME） was introduced. The patients were divided into two groups based on the operation： abdominoperineal resection （APR） or SP surgery. SP rates, leakage and other clinicopathological characteristics were compared between the two time periods and between the two different groups. Results The SP rate increased significantly over the 12 years, from 44.9% in period Ⅰ to 76.2% in period Ⅱ （P=0.000）. The factors significantly influencing SP included the distance of the tumor from the anorectal line, gender, time period, circumference of intramural spread and histological differentiation （P 〈0.05）. Significant differences were detected between the two time periods in gender, blood transfusion volume and Dukes＇ stage （P 〈0.05）. The leakage rate was 2.7% in period I and 1.3% in period II （P 〉0.05）. Conclusions Over the 12-year period of the study the SP rate in rectal cancers 1-5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME. However, TME had no effect on operating time and leakage rates.展开更多
AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great sha...AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great share to this dismal result. Clinicopathologic examination of distal mesorectum in lower rectal cancer was performed in the present study to assess the incidence and extent of distal mesorectal spread and to determine an optimal distal resection margin in sphincter-saving procedure.METHODS: We prospectively examined sepecimens from 45 patients with lower rectal cancer who underwent curative surgery. Large-mount sections were performed to microscopically observe the distal mesorectal spread and to measure the extent of distal spread. Tissue shrinkage ratio was also considered. Patients with involvement in the distal mesorectum were compared with those without involvement with regard to clinicopathologic features.RESULTS: Mesorectal cancer spread was observed in 21patients (46.7%), 8 of them (17.8%) had distal mesorectal spread. Overall, distal intramural and/or mesorectal spreads were observed in 10 patients (22.2%) and the maximum extent of distal spread in situ was 12 mm and 36 mm respectively. Eight patients with distal mesorectal spread showed a significantly higher rate of lymph node metastasis compared with the other 37 patients without distal mesorectal spread (P = 0.043).CONCLUSION: Distal mesorectal spread invariably occurs in advanced rectal cancer and has a significant relationship with lymph node metastasis. Distal resection margin of 1.5 cm for the rectal wall and 4 cm for the distal mesorectum is proper to those patients who are arranged to receive operation with a curative sphincter-saving procedure for lower rectal cancer.展开更多
文摘Background Total mesorectal excision （TME） has increased the rate of sphincter-preservation （SP） for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors. MethOds We reviewed retrospectively the medical records of 316 patients with lower rectal cancers, 1 to 5 cm from the anorectal line, who had surgical resections from August 1994 to November 2005. The 12-year span was divided into 2 periods： period Ⅰ（August 1994-December 1998） and period Ⅱ （January 1999-November 2005）, based on the date （January 1999） when standard total mesorectal excision （TME） was introduced. The patients were divided into two groups based on the operation： abdominoperineal resection （APR） or SP surgery. SP rates, leakage and other clinicopathological characteristics were compared between the two time periods and between the two different groups. Results The SP rate increased significantly over the 12 years, from 44.9% in period Ⅰ to 76.2% in period Ⅱ （P=0.000）. The factors significantly influencing SP included the distance of the tumor from the anorectal line, gender, time period, circumference of intramural spread and histological differentiation （P 〈0.05）. Significant differences were detected between the two time periods in gender, blood transfusion volume and Dukes＇ stage （P 〈0.05）. The leakage rate was 2.7% in period I and 1.3% in period II （P 〉0.05）. Conclusions Over the 12-year period of the study the SP rate in rectal cancers 1-5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME. However, TME had no effect on operating time and leakage rates.
基金Supported by the Key Project of National Outstanding Youth Foundation of China, No. 39925032
文摘AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great share to this dismal result. Clinicopathologic examination of distal mesorectum in lower rectal cancer was performed in the present study to assess the incidence and extent of distal mesorectal spread and to determine an optimal distal resection margin in sphincter-saving procedure.METHODS: We prospectively examined sepecimens from 45 patients with lower rectal cancer who underwent curative surgery. Large-mount sections were performed to microscopically observe the distal mesorectal spread and to measure the extent of distal spread. Tissue shrinkage ratio was also considered. Patients with involvement in the distal mesorectum were compared with those without involvement with regard to clinicopathologic features.RESULTS: Mesorectal cancer spread was observed in 21patients (46.7%), 8 of them (17.8%) had distal mesorectal spread. Overall, distal intramural and/or mesorectal spreads were observed in 10 patients (22.2%) and the maximum extent of distal spread in situ was 12 mm and 36 mm respectively. Eight patients with distal mesorectal spread showed a significantly higher rate of lymph node metastasis compared with the other 37 patients without distal mesorectal spread (P = 0.043).CONCLUSION: Distal mesorectal spread invariably occurs in advanced rectal cancer and has a significant relationship with lymph node metastasis. Distal resection margin of 1.5 cm for the rectal wall and 4 cm for the distal mesorectum is proper to those patients who are arranged to receive operation with a curative sphincter-saving procedure for lower rectal cancer.
