[Total excision of the mesorectum in XXXX of the lower and middle rectum. Oncological and functional results].

@entity1 @entity834 @entity1494 @entity5 @entity190 @entity420
INTRODUCTION: The introduction of total mesorectal excision (TME) in the treatment of @entity5 has improved survival rates and decreased recurrence. Our objective was to analyse perioperative data as well as the results of the follow-up examination. Risk-factors for local recurrence should be identified since the indication for adjuvant therapy in "optimal surgery" has to be redefined. @entity1 AND METHODS: Between March 1997 and December 2001, 108 @entity1 with @entity420 of the lower and middle rectum were operated on by three surgeons according to the concept of total mesorectal excision. In 75 (69.4%) @entity1 ,a lower anterior resection and in 32 (29.2%) cases an abdominoperineal resection was performed. One @entity1 received a Hartmann's resection. There were 15 cases of stage IV (UICC) present and in 53 @entity1 the @entity5 extension was restricted to the wall. Demographic and perioperative data as well as the results of the follow-up examination were registered prospectively. The median follow-up period amounted to 24 months (2-56). RESULTS: A total of 87 @entity1 underwent a curative resection. Fourteen lymph nodes were dissected (median). Pelvic autonomic nerve preservation was possible in 90 @entity1 . The median intraoperative @entity190 was 500 ml. As surgical complications, @entity834 occurred in 18% of cases, perineal wound infection in 33%, and @entity1494 (requiring catheterisation) in 5.6%. The overall rate of recurrence was 17.5%. The rate of local recurrence was 4.9% and the survival rate was 91% over 3 years. Risk factors for local recurrence are N2-disease, transmural growth and @entity5 localisation in the lower third of the rectum. CONCLUSIONS: TME offers good oncological and functional results with low complication rates for the treatment of @entity5 in the middle and upper third of the rectum. Interdisciplinary multicenter studies are still necessary to redefine the place of adjuvant radiation and chemotherapy in cases of @entity5 in the lower two thirds of the rectum and @entity5 .
