TME quality in rectal cancer surgery

Abstract

Background The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann's procedure (6%; 6/103) or colectomy (2%; 2/103). Results In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95). Conclusion Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.

Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry

“…0: no tumor regression; 1: dominant tumor mass with obvious fibrosis and/or vasculopathy; 2: dominantly fibrotic changes with few tumor cells or groups (easy to find); 3: very few (difficult to find microscopically) tumor cells in fibrotic tissue with or without mucous substance; 4: no tumor cells, only fibrotic mass (total regression or response). The quality of TME was graded according to the M.E.R.C.U.R.Y.-classfication [17,18] system into 3 grades: complete, nearly complete and incomplete. Histopathological examination is based on the mesorectal integrity, the existence of defects, the conical conformation of the excised tumor specimen and the regularity of the circumferential resection margin (CRM).…”

Review of the quality of total mesorectal excision does not improve the prediction of outcome

“…The macroscopic evaluation of the quality of total mesorectal excision (TME) for rectal cancer has been assessed in randomized trials and observational single‐centre studies . Three grades were introduced by Quirke et al .…”

Optimize the dose of oxaliplatin for locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by radical surgery and adjuvant chemotherapy

“…Staging in this study was based on the TNM staging classification (8th edition) of the Union for International Cancer Control / American Joint Cancer Committee, both before treatment and after surgery. TME quality was assessed based on MECURY criteria [12]. TRG was based on Mandard's five-tier grading system [13], in which TRG 1-2 and 3-5 were defined as good and bad responders, respectively.…”