This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Recurrence and survival after mesorectal excision for rectal cancer. BJS 2003; 90: 974-980.
Published: 15th May 2003
Authors: S. Bülow, I. J. Christensen, H. Harling, O. Kronborg, C. Fenger, H. J. Nielsen et al.
Background
Mesorectal excision for rectal cancer has resulted in local recurrence rates of 3–11 per cent compared with up to 38 per cent after conventional methods. The results of a prospective Danish study with a historical control group are presented.
Method
Three hundred and eleven patients with a mobile rectal cancer had mesorectal excision with curative intent performed by certified surgeons and were followed for 3 years. Demographic, perioperative and follow‐up data were recorded prospectively. A series of patients who had conventional operations for rectal cancer served as a control group.
Results
The cumulative 3‐year local recurrence rate was 11 per cent after mesorectal excision compared with 30 per cent after conventional surgery (hazard ratio (HR) 0·33 (95 per cent confidence interval (c.i.) 0·21 to 0·52); P < 0·001). Multivariate regression analysis showed that only advanced age (HR 0·97 (95 per cent c.i. 0·94 to 1·00); P = 0·048) and tumour in the lower third of the rectum (HR 0·21 (95 per cent c.i. 0·04 to 1·97); P = 0·075) were marginal independent predictors of local recurrence after mesorectal excision. The cumulative crude 3‐year survival rate was 77 per cent after mesorectal excision and 62 per cent after conventional surgery (HR 0·58 (95 per cent c.i. 0·43 to 0·77); P < 0·001). Age was the only independent predictor of death after mesorectal excision (HR 1·04 (95 per cent c.i. 1·02 to 1·07); P = 0·001).
Conclusion
Mesorectal excision is associated with a considerably lower risk of local recurrence and a better survival rate than conventional surgery, and is the optimum method for rectal cancer resection. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Full text