Local recurrence after curative excision for rectal cancer is frequently regarded as a failure of surgery.
The macroscopic quality of the excised mesorectum after total mesorectal excision has been proposed as a means of assessment of the adequacy of surgery.
Dr John Hartley and colleagues from England determined the utility of mesorectal grading in prediction of local and overall recurrence after curative surgery between 2001 and 2003.
The team prospectively applied mesorectal grading to the resection specimens of 130 patients undergoing resection for primary adenocarcinoma of the rectum.
The research team undertook the grading according to the classification proposed by Quirke and colleagues, with Grades 1 being the worst and Grade 3 the best.
Prognostic significance of mesorectal grades was determined by multivariate regression analyses.
|Recurrence rates were 59% with Grade 1 vs 2% with Grade 3|
|Diseases of the Colon & Rectum|
The researchers found that the local and overall recurrences were 8% and 15%, respectively.
The mesorectum was reported as Grade 3 in 47% of patients, Grade 2 in 40% of patients, and Grade 1 in 13% of patients.
Patients with Grade 1 mesorectum had 41% local recurrence, and 59% overall recurrence, respectively.
However, the team noted that patients with Grade 2 mesorectum had 6% and 2% local and overall recurrence rates, respectively.
Patients with Grade 3 mesorectum had local and overall recurrence rates of 17% and 2%, respectively.
The researchers observed that grade of mesorectum independently influenced both local and overall recurrences.
Dr Hartley's team concludes, “The macroscopic quality of mesorectum after curative excision of rectal cancer is an important predictor of local and overall recurrences.”
“The mesorectal grades may be of value in decisions regarding postoperative adjuvant therapy.”