The treatment of rectal cancer TME

By | April 10, 2012

Enveloping the mesorectum that around the rectum, pelvic visceral fascia within all fat, blood vessels and lymphatic tissues. TME put forward, mainly for surgical treatment of rectal cancer after high local recurrence rate. Our department in 10 years of clinical work, the principles of TME will be applied to rectal cancer surgery practice, and focus on the total mesorectal excision and rectal cancer surgery combination of progress in other areas, so local pelvic rectal cancer lower recurrence rate, higher rate of sphincter preservation, effectively preserves the function of pelvic organs and improve the quality of life of cancer patients, 3-year survival rate is satisfactory.
Traditional surgery 5-year survival rate is 27% -42%, local recurrence rates reported in the world in about 30%. Reasons for local recurrence, there are many possible relevant factors, because the majority of local recurrence in the intestine outside and most of the recurrence is associated with the stage, almost all of the local recurrence Juxian Yu mesorectum, which is the pelvic visceral intraperitoneal. Therefore, the risk factors of local recurrence of tumor was believed to be primarily local mesorectal excision is not thorough enough or clean enough.
Study found that the mesorectum can occur in lymph node metastasis 4 cm distal from the tumor site, the traditional surgical method about 1 / 4 patients in the surgical specimens far there mesangial transfer. Example of one pair of 198 patients retrospective study of rectal specimens found, 10.6% of the specimens there mesangial the transfer of more than 2 cm proximal, distal more than 1 cm, for the wrong change, 20% of the specimens found, distal mesorectum lymph node metastases, the furthest case of more than 4 cm margin.
Rectal cancer after surgical treatment, local recurrence is the most important risk factor for total mesorectal excision is not enough.TME can significantly reduce the local recurrence rate. These results are confirmed by multivariate analysis. In 1985-1991, the number of countries, including the historic, including the 1581 case control study, the average follow-up time was 13.1 years, change from the traditional surgical method after total mesorectal excision, local recurrence rate from 39.4% down to 9.8%, 5-year survival rate from 50% to 71%.
TME technique using precise sharp dissection techniques in the pelvis under direct vision dirty, the separation between the parietal fascia. Department should pay attention to maintaining the integrity of the membrane. This surgery is not a new cancer surgery, because the rectum, the lower no serosal layer, so the tumor can grow around the wall directly to the rectum, which is the violation of the so-called mesorectum. Here the mesorectum and the rectum should be considered as a whole, the visceral pelvic fascia can be understood as rectal serosa.
In TME, maintaining the integrity of mesentery, mesorectum to avoid damage and incomplete resection, in fact, followed the principle of en bloc resection of tumor surgery and the tumor-free technique. Emphasize here that the sharp separation under direct vision, is used for blunt dissection of the tumor tissue is equivalent to the extrusion and contacts easily lead to mesangial damage, cancer spillover, resulting in local cultivation and metastasis.

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