The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Factors influencing the quality of total mesorectal excision. BJS 2012; 99: 714-720.

Published: 6th February 2012

Authors: B. Garlipp, H. Ptok, U. Schmidt, P. Stübs, H. Scheidbach, F. Meyer et al.

Background

Total mesorectal excision (TME) has become the standard of care for rectal cancer. Incomplete TME may lead to local recurrence.

Method

Data from the multicentre observational German Quality Assurance in Rectal Cancer Trial were used. Patients undergoing low anterior resection for rectal cancer between 1 January 2005 and 31 December 2009 were included. Multivariable analysis using a stepwise logistic regression model was performed to identify predictors of suboptimal TME.

Results

From a total of 6179 patients, complete data sets for 4606 patients were available for analysis. Pathological tumour category higher than T2 (pT3 versus pT1/2: odds ratio (OR) 1·22, 95 per cent confidence interval 1·01 to 1·47), tumour distance from the anal verge less than 8 cm (OR 1·27, 1·05 to 1·53), advanced age (65–80 years: OR 1·25, 1·03 to 1·52; over 80 years: OR 1·60, 1·15 to 2·22), presence of intraoperative complications (OR 1·63, 1·15 to 2·30), monopolar dissection technique (OR 1·43, 1·14 to 1·79) and low case volume (fewer than 20 procedures per year) of the operating surgeon (OR 1·20, 1·06 to 1·36) were independently associated with moderate or poor TME quality.

Conclusion

TME quality was influenced by patient‐ and treatment‐related factors. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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