Turkish Journal of Colorectal Disease (Jun 2024)

Partial Versus Total Mesorectal Excision for the Surgical Treatment of Mid-Rectal Cancer: An Assessment from the Turkish Society of Colon and Rectal Surgery’s Colorectal Cancer Database

  • Volkan Özben,
  • Nuri Okkabaz,
  • Turkish Colorectal Cancer Database Study Group

DOI
https://doi.org/10.4274/tjcd.galenos.2024.2024-2-1
Journal volume & issue
Vol. 34, no. 2
pp. 41 – 49

Abstract

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Aim: Although total mesorectal excision (TME) is standard, partial mesorectal excision (PME) is increasingly performed in upper rectal cancer to preserve a longer rectal stump, potentially improving outcomes. However, data on the role of PME in mid-rectal cancer are limited. This study aims to assess the short-term clinicopathological outcomes of PME in mid-rectal cancer. Method: The Turkish Society of Colon and Rectal Surgery’s colorectal cancer database was searched for patients undergoing surgery for mid-rectal cancer between July 2018 and December 2022. The patients were divided into PME and TME groups and histopathological and 30-day clinical outcomes were compared. Results: The study included 158 patients: 24 (15%) in the PME group and 134 (85%) in the TME group. There were no significant differences in perioperative data, except for tumor stage, neoadjuvant treatment, and stoma creation (58.3% in PME vs. 85.8% in TME, p=0.004). No differences were observed in nodal harvest (18.6±8.5 in PME vs. 15.6±9.2 in TME), quality of mesorectal excision, or positivity of radial and distal margins (8.3% in PME vs. 5.2% in TME). Multivariate analysis showed that PME was associated with a similar likelihood of distal margin positivity [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.02-19.08, p=0.88], radial margin positivity (OR: 9.95, 95% CI: 0.22-522.17, p=0.22), nodal harvest (1.28, 95% CI: -1.62-7.70, p=0.20), anastomotic leak (OR: 0.30, 95% CI: 0.01-2.60, p=0.33), and stoma formation (OR: 0.67, 95% CI: 0.19-2.44, p=0.53). Conclusion: PME does not compromise surgical resection margins or short-term outcomes in patients with mid-rectal cancer. These findings need confirmation with larger cohorts, and additional studies are necessary to evaluate functional outcomes.

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