Department of Surgery III, Coimbra University Medical School and Coimbra University Hospital, Coimbra, Portugal.
Colorectal Dis. 2011 Apr;13(4):381-6. doi: 10.1111/j.1463-1318.2009.02153.x.
Local recurrence after resection of rectal cancer is usually regarded as being due to a 'failure' of surgery. The completeness of resection of the mesorectum has been proposed as an indicator of the 'quality' of the resection. We determined the prognostic value of macroscopic evaluation of rectal cancer resection specimens and the circumferential resection margin (CRM) after curative surgery.
From 1999 to 2006, the macroscopic quality of the mesorectum and the CRM were prospectively assessed in 127 patients who underwent rectal cancer resection with curative intent (R0+R1). Chemoradiotherapy was administered for 61 tumours staged as locally advanced tumours (T3, T4 and N+). Univariate analysis of time to local recurrence and cancer-free survival were tested (Kaplan-Meier) and multivariate analysis calculated with a Cox regression model.
The mesorectum was incomplete in 34 (26.8%) patients. At a median follow up of 34 months (range, 9-96 months), in the group with an adequate mesorectal excision, the cumulative risk of local recurrence at 5 years was 10%. This was 25% if the mesorectum was incomplete (P < 0.01). Five-year cancer-free survival was 65% if the mesorectal excision was adequate and 47% if it was not (P < 0.05). Multivariate analysis identified T status, the CRM and the mesorectal score as independent factors for local recurrence, and T and N status and the mesorectal score as independent factors for disease-free survival.
The outcome of surgical treatment of rectal cancer is related to the completeness of mesorectal excision. It is a more discriminative prognostic factor than the classic tumour-node-metastasis (TNM) system.
直肠癌切除术后的局部复发通常被认为是手术“失败”的结果。直肠系膜的切除完整性已被提出作为手术“质量”的指标。我们确定了根治性手术后直肠癌切除标本的宏观评估和环周切缘（CRM）的预后价值。
从 1999 年到 2006 年，前瞻性评估了 127 例接受根治性直肠癌切除术（R0+R1）的患者的直肠系膜宏观质量和 CRM。对 61 例局部进展期肿瘤（T3、T4 和 N+）进行了放化疗。使用 Kaplan-Meier 进行了局部复发和无癌生存时间的单因素分析，并使用 Cox 回归模型进行了多因素分析。
34 例（26.8%）患者的直肠系膜不完整。在中位随访 34 个月（范围 9-96 个月）时，在充分切除直肠系膜的患者中，5 年局部复发的累积风险为 10%。如果直肠系膜不完整，这一比例为 25%（P<0.01）。如果直肠系膜切除充分，5 年无癌生存率为 65%，否则为 47%（P<0.05）。多因素分析确定 T 分期、CRM 和直肠系膜评分是局部复发的独立因素，T 和 N 分期和直肠系膜评分是无病生存的独立因素。
直肠癌手术治疗的结果与直肠系膜切除的完整性有关。它是比经典的肿瘤-淋巴结-转移（TNM）系统更具鉴别力的预后因素。
