Factors associated with noncomplete mesorectal excision following surgery for rectal adenocarcinoma

• Published in: The American journal of surgery Vol. 217; no. 3; pp. 465 - 468
• Main Authors: Sapci, Ipek, Velazco, Jorge Silva, Xhaja, Xhileta, Aiello, Alexandra, Gorgun, Emre, Stocchi, Luca, Delaney, Conor P., Steele, Scott R., Valente, Michael A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Limited
• Subjects: Abdominoperineal resection; Adenocarcinoma; Cancer surgery; Colorectal cancer; Complete mesorectum; Demographic variables; Demographics; Demography; Evaluation; Grading; Laparoscopy; Mesorectal grade; Multivariate analysis; Pathology; Patients; Rank tests; Rectum; Robotics; Surgery; Survival; Total mesorectal excision; Tumors; Total mesorectal excision; Mesorectal grade; Abdominoperineal resection; Complete mesorectum
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.10.051

The completeness of the resected mesorectum is a quality metric in rectal cancer surgery and has been related to oncological outcomes. Our aim was to identify variables associated with non-complete mesorectal excision and determine any effect on overall survival. Consecutive patients who underwent curative intent surgery for rectal adenocarcinoma (2009–2016) were identified from a prospectively-maintained institutional database. Patients were grouped according to their mesorectal grade: complete, near-complete and incomplete. Multivariate analysis was performed to identify the association between various patient, disease and surgeon-related characteristics and mesorectal grading. Log-rank tests were used to evaluate any difference in overall survival between the groups. 689 patients met inclusion criteria. Demographics and perioperative variables were comparable between the groups. On multivariate analysis, abdominoperineal resection, and involved circumferential resection margin were significantly associated with non-complete mesorectum. Finally, patients with non-complete mesorectal grading have approximately twice the hazard of death compared to those with complete mesorectal grading. Several factors are associated with a non-complete mesorectal excision. Non-complete mesorectal grade is associated with decreased survival. •Non-complete mesorectum is associated with low rectal tumors and abdominoperineal resection.•Patients with non-complete mesorectal grade have twice the hazard of death compared to those with complete mesorectal grade.•Abdominoperineal resection or positive circumferential resection margin are independently related to obtaining a non-complete mesorectum.