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Operative Safety and Oncologic Outcomes of Anal Sphincter-Preserving Surgery with Mesorectal Excision for Rectal Cancer: 931 Consecutive Patients Treated at a Single Institution

Abstract

Background

This study was designed to evaluate the operative safety and long-term oncologic outcomes of sphincter-preserving surgery based on sharp mesorectal excision for rectal cancer.

Methods

Between January 1989 and June 2004, 931 patients underwent sphincter-preserving surgery based on sharp mesorectal excision. The operative safety and oncologic outcomes were assessed for the periods of 1989–1996 (n = 208) and 1997–2004 (n = 723). Total mesorectal excision (TME)-based sphincter-preserving surgery was performed during the period of 1989–1996. A multidisciplinary team approach and tailored mesorectal excision, which is the differential removal of the mesorectum, were our standard treatment for patients with rectal cancer during the period of 1997–2004.

Results

The use of preoperative chemoradiation (P < 0.001), ultralow anterior resection with coloanal anastomosis (P = 0.01), diverting stoma (P = 0.001), and <2 cm of a distal resection margin (P = 0.01) were more common during the period of 1997–2004. There were no differences between the two periods with regard to perioperative complications (P = 0.2), such as anastomosis leakage (2.4% vs. 3.6%). Cancer-specific survival rates (79.1% vs. 79.6%, P = 0.7) and local recurrence (8.4% vs. 8.6%, P = 0.99) did not differ significantly for the two periods.

Conclusions

Based on sharp mesorectal excision, operative safety and oncologic outcomes were not compromised by technical advances in sphincter-preserving surgery using tailored mesorectal excision and a shortened distal margin.

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ACKNOWLEDGEMENTS

Supported by grants from the Korean Health 21 R & D Project, Ministry of Health and Welfare, Republic of Korea (0412-CR01-0704-0001, 0405-BC01-0604-0002).

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Correspondence to Nam-Kyu Kim MD.

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Kim, NK., Kim, YW., Min, BS. et al. Operative Safety and Oncologic Outcomes of Anal Sphincter-Preserving Surgery with Mesorectal Excision for Rectal Cancer: 931 Consecutive Patients Treated at a Single Institution. Ann Surg Oncol 16, 900 (2009). https://doi.org/10.1245/s10434-009-0340-9

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Keywords

  • Rectal Cancer
  • Total Mesorectal Excision
  • Anal Verge
  • Preoperative Therapy
  • Preoperative Chemoradiation