Extrafascial excision of the rectum for rectal cancer

Hill, Graham L.; Rafique, Mohammad

doi:10.1046/j.1365-2168.1998.00735.x

Cited by 50 publications

(36 citation statements)

References 17 publications

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“…After the introduction of TME the rate of local recurrence could be dramatically reduced [1]. Even without curative approach, local recurrence was reduced to 6-12% and 5-year survival rate improved to 53-87% [2-4]. However, it is noteworthy, that the excellent results of a local recurrence rate of less than 5% without neoadjuvant treatment modalities as reported by Heald have not been reached by the majority of rectal surgeons [1].…”

Section: Introductionmentioning

confidence: 99%

TME quality in rectal cancer surgery

et al. 2010

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Background The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann's procedure (6%; 6/103) or colectomy (2%; 2/103). Results In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95). Conclusion Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.

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Section: Introductionmentioning

confidence: 99%

TME quality in rectal cancer surgery

et al. 2010

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“…Adjuvant radiochemotherapy reduces local recurrence rates by one-third. Applying the technique of TME (Total Mesorectal Excision), some surgeons have reported locoregional recurrence rates lower than that have ever been reported from series using adjuvant therapy after "standard" surgery [6,13,21,23,45]. It is not clear whether the excellent results of TME reported by these surgeons are reproducible in a multicenter setting.…”

Section: Discussionmentioning

confidence: 70%

The Postoperative Adjuvant Radiation Therapy and Radiochemotherapy for UICC Stage II and III Rectal Cancer A Retrospective Analysis

et al. 2000

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Prognosis of patients with UICC Stage III rectal cancer remains poor after "standard" surgery followed by postoperative adjuvant treatment (pelvic radiotherapy and bolus intravenous injection of 5-FU and leucovorin). Major efforts should be made in order to improve prognosis for these patients, including optimization of surgical treatment and systemic treatment. More effective multimodality treatment strategies should be investigated in prospective randomized trials.

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“…Use of these additional gross anatomical landmarks may help minimize nerve damage during procedures such as mesorectal excision (Enker et al, 1995;Aeberhard and Fasolini, 1998;Kirkham et al, 2001) and radical prostatectomy (Catalona and Dresner, 1985;Kursh and Bodner, 1988;Narayan, 1991). In these surgical procedures, the nerves contributing to the pelvic plexus are generally identified visually, for example in the fascia propria after mobilization of the rectum (Hill and Rafique, 1998;Chapuis et al, 2002). On occasion, however, the intraoperative field of view may be restricted and the gross anatomical landmarks described here might then become useful.…”

Section: Discussionmentioning

confidence: 96%

Anatomy of the pelvic plexus and innervation of the prostate gland

et al. 2004

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We have examined the anatomy of the pelvic (inferior hypogastric) plexus in six male cadavers, paying particular attention to gross anatomical landmarks that might aid in locating it and have used immunohistochemistry to study the small branches of the plexus that supply the prostate gland. The pelvic plexus was found two finger breadths lateral to the third anterior sacral foramina, lying deep to a line drawn from third sacral vertebra, the conventional level of the recto-sigmoid junction, and the palpable posterior superior surface of the pubic symphysis. Immunohistochemical staining showed small nerve branches from the pelvic plexus entering the prostate gland and the presence of ganglia within the prostate gland that contained both tyrosine hydroxylase positive and negative neuronal cell bodies. This information may be useful in nerve-sparing surgical procedures and in discussions of the functional implications of perturbations of prostate innervation.

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Extrafascial excision of the rectum for rectal cancer

Abstract: If the cancer is contained within the fascial tube surrounding the rectum and complete extrafascial excision has been performed, local recurrence will be minimal.

Cited by 50 publications

References 17 publications

TME quality in rectal cancer surgery

TME quality in rectal cancer surgery

The Postoperative Adjuvant Radiation Therapy and Radiochemotherapy for UICC Stage II and III Rectal Cancer A Retrospective Analysis

Anatomy of the pelvic plexus and innervation of the prostate gland

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