This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (355)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Gastrointestinal/ Upper Foregut  • Alert me on articles by topic

The Basingstoke Experience of Total Mesorectal Excision, 1978-1997

Richard J. Heald, MChir, FRCS; Brendan J. Moran, MCh, FRCS; Roger D. H. Ryall, FRCR; Rosemary Sexton, BSc; John K. MacFarlane, MD

Arch Surg. 1998;133:894-898.

Objective  To examine the role of total mesorectal excision in the management of rectal cancer.

Design  A prospective consecutive case series.

Setting  A district hospital and referral center in Basingstoke, England.

Patients  Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation.

Interventions  Anterior resections (n=465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal resections (n=37), Hartmann resections (n=10), local excisions (n=4), and laparotomy only (n=3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal resections, 38 with anterior resections, 3 with Hartmann resections, and 1 with laparotomy).

Main Outcome Measures  Local recurrence and cancer-specific survival.

Results  Cancer-specific survival of all surgically treated patients was 68% at 5 years and 66% at 10 years. The local recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence interval, 2%-14%) at 10 years. In 405 "curative" resections, the local recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence interval, 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years and 78% at 10 years. An analysis of histopathological risk factors for recurrence indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as variables in these results.

Conclusions  Rectal cancer can be cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all stages and in 4 of 5 patients having curative resections. In future clinical trials of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal excision as the surgical procedure of choice.

From the Colorectal Research Unit, The North Hampshire Hospital, Basingstoke (Messrs Heald and Moran and Ms Sexton), and Wessex Radiotherapy Centre, Southampton (Mr Ryall), Hampshire, England, and University of British Columbia, Vancouver (Dr MacFarlane).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Treatment of the elderly colorectal cancer patient: SIOG expert recommendations
Papamichael et al.
Ann Oncol 2008;0:mdn532v1-mdn532.
ABSTRACT | FULL TEXT  

Patterns of Recurrence Following Liver Resection for Colorectal Metastases: Effect of Primary Rectal Tumor Site
Assumpcao et al.
Arch Surg 2008;143:743-749.
ABSTRACT | FULL TEXT  

Extended Perineal Resection of Distal Rectal Cancers: Surgical Advance, Increased Utilization of Neoadjuvant Therapies, Proper Patient Selection or All of the Above?
Guillem and Minsky
JCO 2008;26:3481-3482.
FULL TEXT  

Patient and Physician Preferences for Surgical and Adjuvant Treatment Options for Rectal Cancer
Harrison et al.
Arch Surg 2008;143:389-394.
ABSTRACT | FULL TEXT  

Factors Influencing Pathologic Results after Total Mesorectal Excision for Rectal Cancer: Analysis of Consecutive 100 Cases
Baik et al.
Ann. Surg. Oncol. 2008;15:721-728.
ABSTRACT | FULL TEXT  

Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated with Preoperative Chemoradiotherapy and Curative Resection
Kim et al.
Ann. Surg. Oncol. 2008;15:729-737.
ABSTRACT | FULL TEXT  

Short-Term Outcomes After Robotic-Assisted Total Mesorectal Excision for Rectal Cancer
Hellan et al.
Ann. Surg. Oncol. 2007;14:3168-3173.
ABSTRACT | FULL TEXT  

Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?
Kuo et al.
Ann. Surg. Oncol. 2007;14:2766-2772.
ABSTRACT | FULL TEXT  

Comparison of Functional and Surgical Outcomes of Laparoscopic-Assisted Colonic J-Pouch Versus Straight Reconstruction After Total Mesorectal Excision for Lower Rectal Cancer
Liang et al.
Ann. Surg. Oncol. 2007;14:1972-1979.
ABSTRACT | FULL TEXT  

Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy
Valenti et al.
Ann. Surg. Oncol. 2007;14:1744-1751.
ABSTRACT | FULL TEXT  

Adjuvant Treatment of Colorectal Cancer
Wolpin et al.
CA Cancer J Clin 2007;57:168-185.
ABSTRACT | FULL TEXT  

Extramural Depth of Tumor Invasion at Thin-Section MR in Patients with Rectal Cancer: Results of the MERCURY Study
MERCURY Study Group
Radiology 2007;243:132-139.
ABSTRACT | FULL TEXT  

Loco-regional Recurrence from Colon Cancer: A Population-based Study
Sjovall et al.
Ann. Surg. Oncol. 2007;14:432-440.
ABSTRACT | FULL TEXT  

Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer
Baik et al.
Ann. Surg. Oncol. 2007;14:462-469.
ABSTRACT | FULL TEXT  

Neoplastic Mesorectal Microfoci (MMF) following Neoadjuvant Chemoradiotherapy: Clinical and Prognostic Implications
Ratto et al.
Ann. Surg. Oncol. 2007;14:853-861.
ABSTRACT | FULL TEXT  

Neoplastic Mesorectal Microfoci (MMF) Following Neoadjuvant Chemoradiotherapy: Clinical and Prognostic Implications
Ratto et al.
Ann. Surg. Oncol. 2006;13:1393-1402.
ABSTRACT | FULL TEXT  

Preoperative staging for rectal cancer.
Finlay
BMJ 2006;333:766-767.
FULL TEXT  

Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203
Gerard et al.
JCO 2006;24:4620-4625.
ABSTRACT | FULL TEXT  

A Pathologic Complete Response of Rectal Cancer to Preoperative Combined-Modality Therapy Results in Improved Oncological Outcome Compared With Those Who Achieve No Downstaging on the Basis of Preoperative Endorectal Ultrasonography
Stipa et al.
Ann. Surg. Oncol. 2006;13:1047-1053.
ABSTRACT | FULL TEXT  

Neoadjuvant Capecitabine and Oxaliplatin Followed by Synchronous Chemoradiation and Total Mesorectal Excision in Magnetic Resonance Imaging-Defined Poor-Risk Rectal Cancer
Chau et al.
JCO 2006;24:668-674.
ABSTRACT | FULL TEXT  

Surgical management of rectal cancer: a multidisciplinary approach to technical and technological advances
Heald
Br. J. Radiol. 2005;78:S128-S130.
FULL TEXT  

Assessing the Quality of Colorectal Cancer Staging: Documenting the Process in Improving the Staging of Node-Negative Colorectal Cancer
Wong et al.
Arch Surg 2005;140:881-887.
ABSTRACT | FULL TEXT  

CHEMORADIOTHERAPY FOR COLORECTAL CANCER
Andre and Schmiegel
Gut 2005;54:1194-1202.
FULL TEXT  

Survival for rectal cancer patients and international comparisons
Kerr et al.
Ann Oncol 2005;16:664-672.
ABSTRACT | FULL TEXT  

Chemoradiotherapy for rectal cancer.
Gaur et al.
NEJM 2005;352:509-511.
FULL TEXT  

A Simple Technique for Identification and Preservation of the Hypogastric Nerves During Rectal Surgery
Morpurgo et al.
Arch Surg 2004;139:1106-1109.
ABSTRACT | FULL TEXT  

Validation of Ex Vivo Lymphatic Mapping in Hematoxylin-Eosin Node-Negative Carcinoma of the Colon and Rectum
Wong et al.
Ann. Surg. Oncol. 2004;11:772-777.
ABSTRACT | FULL TEXT  

Preoperative radiotherapy for rectal cancer
Salerno et al.
JRSM 2004;97:361-362.
FULL TEXT  

Improved Sphincter Preservation in Low Rectal Cancer With High-Dose Preoperative Radiotherapy: The Lyon R96-02 Randomized Trial
Gerard et al.
JCO 2004;22:2404-2409.
ABSTRACT | FULL TEXT  

Case 18-2004 - A 61-Year-Old Man with Rectal Bleeding and a 2-cm Mass in the Rectum
Shellito et al.
NEJM 2004;350:2500-2509.
FULL TEXT  

Are We Overtreating Rectal Cancer: Time for Another Trial?
Carne and Nelson
Ann. Surg. Oncol. 2004;11:124-126.
FULL TEXT  

High-Resolution MRI of the Anatomy Important in Total Mesorectal Excision of the Rectum
Brown et al.
Am. J. Roentgenol. 2004;182:431-439.
ABSTRACT | FULL TEXT  

Preoperative Concurrent Chemoradiotherapy in Locally Advanced Rectal Cancer With High-Dose Radiation and Oxaliplatin-Containing Regimen: The Lyon R0-04 Phase II Trial
Gerard et al.
JCO 2003;21:1119-1124.
ABSTRACT | FULL TEXT  

Adequacy of 1-cm Distal Margin After Restorative Rectal Cancer Resection With Sharp Mesorectal Excision and Preoperative Combined-Modality Therapy
Moore et al.
Ann. Surg. Oncol. 2003;10:80-85.
ABSTRACT | FULL TEXT  

Radical Resection of Rectal Cancer Primary Tumor Provides Effective Local Therapy in Patients With Stage IV Disease
Nash et al.
Ann. Surg. Oncol. 2002;9:954-960.
ABSTRACT | FULL TEXT  

Surgery for colorectal cancer
Dorudi et al.
Br Med Bull 2002;64:101-118.
ABSTRACT | FULL TEXT  

Management of colorectal cancer
Leslie and Steele
Postgrad. Med. J. 2002;78:473-478.
ABSTRACT | FULL TEXT  

Adjuvant Therapy in Rectal Cancer: Analysis of Stage, Sex, and Local Control--Final Report of Intergroup 0114
Tepper et al.
JCO 2002;20:1744-1750.
ABSTRACT | FULL TEXT  

Complete Response to Neoadjuvant Chemoradiation for Rectal Cancer Does Not Influence Survival
Onaitis et al.
Ann. Surg. Oncol. 2001;8:801-806.
ABSTRACT | FULL TEXT  

Impact of Surgical and Pathologic Variables in Rectal Cancer: A United States Community and Cooperative Group Report
Stocchi et al.
JCO 2001;19:3895-3902.
ABSTRACT | FULL TEXT  

Adjuvant Radiation Therapy of Rectal Cancer
Tepper
JCO 2001;19:3709-3711.
FULL TEXT  

Refining Multimodal Therapy for Rectal Cancer
Nelson and Sargent
NEJM 2001;345:690-692.
FULL TEXT  

Guidelines 2000 for Colon and Rectal Cancer Surgery
Nelson et al.
JNCI J Natl Cancer Inst 2001;93:583-596.
ABSTRACT | FULL TEXT  

Impact of Number of Nodes Retrieved on Outcome in Patients With Rectal Cancer
Tepper et al.
JCO 2001;19:157-163.
ABSTRACT | FULL TEXT  

Local Excision of Rectal Carcinoma
Varma et al.
Arch Surg 1999;134:863-868.
ABSTRACT | FULL TEXT  

Invited Critique: Whole-Body PET Imaging With [18F]Fluorodeoxyglucose in Management of Recurrent Colorectal Cancer
Wexner
Arch Surg 1999;134:511-513.
FULL TEXT