Ferko A, Orhalmi J, Nikolov D H, Hovorková E, Chobola M, Vošmik M, Cermáková E
Chirurgicka Klinika, LF a FN Hradec Kralove.
Rozhl Chir. 2013 Jun;92(6):304-10.
Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision.
Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery.
168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmanns procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) - 11 out of 27 (41%), and Hartmanns operation - 6 out of 10 (60%). Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors associated with incomplete mesorectal excision. It was the location of the tumour in the distal third of the rectum and the (y)pT stage of the tumour.
Distal rectum tumor location and higher (y)pT are associated with a higher risk of incomplete mesorectal excision with worse patient prognosis.
环周切缘（pCRM）和直肠系膜切除完整性（ME）是与手术治疗根治性显著相关的两个独立预后因素。pCRM阳性和直肠系膜切除不完整与局部复发发生率显著升高及患者预后较差相关。本文旨在分析与直肠系膜切除不完整相关的危险因素。
纳入2011年1月至2013年2月在赫拉德茨克拉洛韦大学医院外科接受手术的患者。前瞻性收集患者数据并录入Dg C20登记册。分析以下因素：性别、年龄、体重指数、cN、pT、临床分期、直肠受累节段、新辅助治疗、肿瘤环周位置、手术入路类型和手术类型。
上述期间共对168例患者进行了手术。在这168例患者中，进行了9例（5.3%）姑息性造口术和159例（94.6%）切除术。7例（4.4%）患者因未评估切除质量而被排除。在其余152例患者中，进行了114例（75%）切除术，包括5例括约肌间切除术。10例（7%）为哈特曼手术，28例（18%）为截肢手术。在152例手术中，69例（45%）通过腹腔镜进行。26例（17%）患者记录有阳性（y）pCRO，主要发生在腹会阴联合切除术（APR）后——27例中有11例（41%），以及哈特曼手术后——10例中有6例（60%）。45例（30%）患者观察到ME不完整，81例（53%）患者ME完整，26例（17%）患者部分完整。单因素分析证实了与直肠系膜切除不完整相关的具有统计学意义的因素：（y）pT（P = 0.00027）、手术类型（P = 0.00001）和肿瘤位置（P = 0.00001）。多因素分析随后证实了与直肠系膜切除不完整相关的两个独立预后因素。即肿瘤位于直肠远端三分之一处以及肿瘤的（y）pT分期。
直肠远端肿瘤位置和较高的（y）pT与直肠系膜切除不完整风险较高及患者预后较差相关。
