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International Journal of Colorectal Disease

, Volume 24, Issue 8, pp 923–929

First Online: 02 June 2009Accepted: 13 May 2009


ObjectiveThe aim of this study was to review the results and long-term outcome after total mesorectal excision TME for adenocarcinoma of the rectum in an unselected population in a community teaching hospital.

Materials and methodsBetween 1996 and 2003, 210 patients with rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathological reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed.

ResultsThe mean age at diagnosis was 69 years range 40–91 years. A total of 145 patients were treated by anterior rectal resection; 65 patients had to undergo an abdominoperineal resection APR. Anastomotic leakage rate was 5%. Postoperative mortality was 3%. After a median follow-up of 3.6 years, the local recurrence-free rate in patients with microscopically complete resections was 91%. The 5-year overall survival rate was 58%. An increased serum carcinoembryonic antigen, an APR, positive lymph nodes, and an incomplete resection all significantly influenced the 5-year overall survival and local recurrence rate. In a multivariate analysis, age was the most important prognostic factor for overall survival.

ConclusionsPatients with rectal cancer can safely be treated with TME in a community teaching hospital and leads to a good overall survival and an excellent local control. In patients aged above 80, treatment-related mortality is an important competitive risk factor, which obscures the positive effect of modern rectal cancer treatment.

KeywordsTME Local recurrence Rectal cancer Carcinoma Radiotherapy CEA AbbreviationsTMEtotal mesorectal excision

LARlow anterior resection

APRabdominoperineal resection

TEMtransanal endoscopic microsurgery

EBRTexternal beam radiation therapy

CEAcarcinoembryonic antigen

CTcomputed tomography

MRImagnetic resonance imaging

AJCCAmerican Joint Committee of Cancer

TNMtumor node metastases

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Author: Floris T. J. Ferenschild - Imro Dawson - Johannes H. W. de Wilt - Eelco J. R. de Graaf - Richard P. R. Groenendijk


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