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Rivista di Medicina Interna

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Panminerva Medica 2000 September;42(3):201-5


lingua: Inglese

Local recurrences and primary surgery in rectal carcinoma

Di Matteo G., Maturo A., Redler A., D’Andrea V., Di Matteo F. M., Montori J., Peparini N., Zeri K. P., Mascagni D.

From the Third Department of Surgery University “La Sapienza”, Rome, Italy


Background. The ­authors ana­lyze ret­ro­spec­tive­ly a con­sec­u­tive ­series of rec­tal car­ci­no­mas oper­at­ed ­on with dif­fer­ent sur­gi­cal strat­e­gies at Third Surgical Department of ''La Sapienza'' University of Rome, ­between January 1985 and December 1997, by one ­expert sur­geon (GDM), and ­report the inci­dence of the ­local recur­rence cor­re­lat­ed to the sur­gi­cal tech­nique devel­op­ment.
Methods. In ­most ­recent ­groups of ­patients treat­ed for extrape­rit­o­neal neo­plasm ­from January 1992 ­with cura­tive (R0) ­total mes­o­rec­tal exci­sion (TME) and ­nerve spar­ing tech­nique (NST) (Group C, n=47) and ­with cura­tive TME ­plus lat­er­al pel­vic lym­phad­e­nec­to­my (LPL) and NST (Group D, n=7), sac­ri­fic­ing the pel­vic auto­nom­ic ner­vous ­system ­only in ­case of neo­plas­tic infil­tra­tion, the ­local recur­rence was 8.5% (4 cas­es, ­with ­mean inter­val of 30.5 ­months) and 0 respec­tive­ly at ­mean fol­low-up of 44.9 and 55 ­months.
Results. In ­none of the ­local recur­renc­es of the Group C a re-resec­tion (nei­ther cura­tive nor pal­li­a­tive) was pos­sible and the sur­vi­val was 50% at 14 ­months ­from the diag­no­sis of ­relapse. Instead, in ­local recur­renc­es of rec­tal car­ci­no­ma in ­patients who under­went a ­first ante­ri­or resec­tion ­with ­less extend­ed dis­sec­tion in oth­er Department (Group E), a re-resec­tion was pos­sible for 3 cas­es out of 4 (R0, R1 and R2 oper­a­tions); re-resect­ed ­patients are now ­alive at ­mean fol­low-up of 33.6 ­months (82, 12 and 7 ­months, respec­tive­ly). In Group A ­patients, treat­ed ­between January 1985 and December 1988 ­with par­tial mes­o­rec­tal exci­sion (R0) ­also for extrap­e­rit­o­neal local­iza­tion, the inci­dence of ­local relaps­es is 21.9% (9/41 cas­es) vs 11.2% (11/98 cas­es) in Group B ­patients, treat­ed ­from January 1989 ­with cura­tive TME for extrap­e­rit­o­neal ­tumors.
Conclusions. The inci­dence of ­local recur­renc­es of extrap­e­rito­neal rec­tal can­cer can be ­reduced by ­total mes­o­rec­tal exci­sion. The ­total spar­ing of pel­vic auto­nom­ic ner­vous ­system in ­advanced rec­tal car­ci­no­ma ­doesn't ­increase the inci­dence of ­local recur­renc­es.

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