The influence of total mesorectal excision on local recurrence and survival in rectal cancer patients: A population‐based study in greater Amsterdam

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Abstract
Background and Objectives: To determine retrospectively in a population‐based setting, the influence of the introduction of total mesorectal excision (TME) on local recurrence and survival in patients with rectal carcinoma.Methods: All rectal carcinomas diagnosed during 1988–1991 (979 patients, conventional surgery with blunt dissection of the rectum) and 1998–2000 (890 patients, TME resection) were selected from the Amsterdam Cancer Registry. For all patients who underwent a macroscopically radical resection in the absence of distant dissemination, information on the occurrence of local recurrent disease and distant metastasis was collected.Results: The cumulative 5‐year recurrence rate decreased significantly from 20% for patients diagnosed in 1988–1991 to 11% in 1998–2000. Stage (T‐category, nodal status), period of diagnosis (conventional surgery vs. TME resection), radiotherapy, and chemotherapy were independent variables of local recurrence in multivariate analysis. There was a non‐significant trend for improved 5‐year relative survival for all rectal carcinoma cases from 52% (95% CI 48–55) for patients diagnosed in 1988–1991 to 59% (95% CI 55–63) in 1998–2000.Conclusions: A significant decrease in local recurrence and a trend for improved relative survival were observed. The broad introduction of TME and the shift towards preoperative radiotherapy are the most plausible explanations for these observations. J. Surg. Oncol. 2007; 95: 447–454.