Our experience of total mesorectal excision for rectal cancer

Introduction: The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald and coll. and has led both to a 5% decrease of local recurrences 5 and 10 years after the operation if confronted with the cases treated with conventional surgery and to the increase of survival up to five years estimated in 80% of the cases. In Italy, TME firstly introduced for distal rectal cancer about 20 years ago, this surgical technique has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer method, has an acceptable risk for the surgery of rectal tumours. Materials and method: We have confronted two groups of patients operated for rectal carcinoma; the first group (no TME, including 50 patients) was treated with the standard surgery technique, while the second group (TME, 44 patients) underwent the total mesorectal excision. 14 no TME patients belong to Dukes stage A, 20 to stage B, 12 to C and the remaining 4 had miscellaneous diagnosis; whereas in the TME group 12 patients belonged to Dukes stage A, 16 to B, 6 to C and the remaining 10 patients had miscellaneous diagnosis. The patients of both groups were undergone the exams of follow up (blood test, hepatic echography, abdominal TC, thorax RX), the follow up pattern expect periodic controls with check-up to three and six months, one and five years. Results: postoperative complications in the groups considered do not show important differences in rates, although, the second group (TME) had 9 cases with postoperative complications confronted with the 11 cases of the first group (no TME). The complications taken into consideration were: anastomotic bleeding (2 patients TME, 4% vs 3 patients no TME, 6%), intestinal obstruction (1 patient TME, 2% vs 1 patient no TME, 2%), paretal infection (3 patients TME, 7% vs 4 patients no TME, 8%), anastomotic fistulae (2 patients TME, 4% vs 2 patients no TME, 4%), retention of urine and vesicular disorder (1 patient TME, 2% vs 1 patient no TME, 2%). Tumours closer to the anus have shown more complications compared with higher ones. As a matter of fact, 10 cases of no TME and TME patients with low placed tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus. A lower rate of local recurrences was noticed in the TME group: 3 (7%) compared with the no TME group: 18 (36%) with P < 0,001. Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 10% vs 6 patients TME, 14%), pulmonary metastasis (5, 10% of the no TME vs 3, 7% of the TME), anastomotic stenosis (4, 8% of the no TME vs 3, 7% of the TME), impotence and orgasm sine materia (2, 4% of the no TME vs 3, 7% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C. Conclusion: from our experience, we deduced that, in TME patients, complications are lower than in no TME patients with no important P; the seat of the tumour affects the appearance of complications which are more frequent in distal localizations. The important result is a minor incidence of recurrences (P < 0,001) which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumours.