Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands

作者：Ellen Kapiteijn, Hein Putter, Cornelis J.�H. van de Velde · 发表于：British journal of surgery · 年份：2002 · DOI：10.1046/j.1365-2168.2002.02196.x · 被引用次数：481 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal Cancer Screening and Detection、Colorectal and Anal Carcinomas

BACKGROUND: Local control and survival following surgical treatment of rectal cancer have been improved by the introduction of total mesorectal excision (TME). The aim of this study was to determine the nationwide impact of the introduction and training of TME on recurrence and survival in rectal cancer. METHODS: Short- and long-term outcomes of a recently published trial of rectal cancer surgery (TME trial) were compared with results from an older trial (cancer recurrence and blood transfusion (CRAB) trial), in which conventional surgery was performed without quality control. Only patients who were operated on with curative intent and who did not receive neoadjuvant radiotherapy were studied. Differences in clinicopathological characteristics were corrected for by multivariate analysis. To ensure valid comparisons, only events that occurred within 2 years of operation were analysed with regard to long-term outcome. RESULTS: In the univariate analysis, a higher clinical anastomotic leak rate was found in patients following low anterior resection in the TME trial (P = 0.046), but this association was not significant in the multivariate analysis. The local recurrence rate decreased from 16 per cent in the CRAB trial to 9 per cent in the TME trial, and type of operation (conventional (CRAB trial) versus TME (TME trial)) was an independent predictor of local recurrence (P = 0.002). Type of operation was also an independent predictor of overall survival (P = 0.019); there was a hi...