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Title: Factors Predicting the Quality of Total Mesorectal Excision for Rectal Cancer
Authors: Leonard, Daniel
Penninckx, Freddy
FIEUWS, Steffen 
Jouret-Mourin, Anne
Sempoux, Christine
Jehaes, Constant
Van Eycken, Elizabeth
Issue Date: 2010
Source: ANNALS OF SURGERY, 252 (6). p. 982-988
Abstract: Objective: To determine preoperative tumor-, patient-, and treatment-related factors that are independently associated with incomplete mesorectal excision. Summary of Background Data: Incomplete total mesorectal excision (TME) for rectal cancer is associated with increased local and overall recurrences. Factors predicting incomplete mesorectal excision have scarcely been studied. Methods: In the context of PROCARE, a Belgian multidisciplinary project on rectal cancer, the quality of 266 consecutive and anonymized TME specimens submitted by 33 candidate-TME-trainers was graded by a blinded pathology review board in a standardized manner. Uni- and multivariable analysis were performed to identify factors that can independently predict incomplete mesorectal excision. Results: Mesorectal resection was complete in 21%, nearly complete in 47%, and incomplete in 32%. Of 57% of TME specimens the grade of resection had not been reported by the local pathologist. Incomplete TME doubled the incidence of a positive circumferential resection margin (P = 0.004). Factors found to be significantly related to incomplete TME in univariate analysis were as follows: surgeon, female gender, pathologic body mass index, low rectal cancer, negative clinical nodal status, the absence of downstaging after long-course chemoradiation, laparoscopic and converted laparoscopic resection, and abdominoperineal resection. Multivariable analysis identified pathologic body mass index (P = 0.017), the absence of downstaging after long-course chemoradiation (P = 0.0005), and laparoscopic or converted laparoscopic resection (P = 0.014) as factors that are independently associated with incomplete mesorectal excision. Conclusion: Good TME quality cannot be guaranteed. This peer-reviewed TME assessment revealed a number of factors that are independently related to incomplete TME. Both specimen and pathology report need to be audited.
Notes: [Penninckx, Freddy] Univ Clin Gasthuisberg, Dept Abdominal Surg, B-3000 Louvain, Belgium. [Leonard, Daniel] St Luc Univ Hosp, Dept Surg & Abdominal Transplantat, Colorectal Surg Unit, Brussels, Belgium. [Fieuws, Steffen] Katholieke Univ Leuven, Dept Biostat 1, Louvain, Belgium. [Fieuws, Steffen] Univ Hasselt, Hasselt, Belgium. [Jouret-Mourin, Anne; Sempoux, Christine] St Luc Univ Hosp, Dept Pathol, Brussels, Belgium. [Jehaes, Constant] Clin St Joseph CHC, Dept Abdominal Surg, Liege, Belgium. [Van Eycken, Elizabeth] Belgian Canc Registry, Brussels, Belgium.
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ISSN: 0003-4932
e-ISSN: 1528-1140
DOI: 10.1097/SLA.0b013e3181efc142
ISI #: 000284603800013
Category: A1
Type: Journal Contribution
Validations: ecoom 2011
Appears in Collections:Research publications

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