MESORECTAL EXCISION FOR RECTAL-CANCER - A VIEW FROM EUROPE

The local recurrence rate after rectal cancer surgery is discussed as related to conventional and total mesorectal excision (TME) techniques . Studies now show that the wide variation in results between centers and among surgeons depends, at least in part, on differences in surgic al technique. We conclude that local tumor recurrence rate is lower af ter TME than after conventional surgery and emphasize the importance o f a standardized macroscopic evaluation of the resected specimen. Popu lation-based registration to evaluate the quality of surgery is recomm ended. It is also suggested that randomized studies on adjuvant treatm ent for rectal cancer should include a ''surgery only'' arm when a loc al tumor recurrence rate of 10% or less is being studied. Until such i nvestigations are performed, we conclude that the role for adjuvant tr eatment is questionable and that TME surgery is preferred as the treat ment option for Stage T1-T3 rectal cancers. Semin. Surg. Oncol. 15:78- 86, 1998. (C) 1998 Wiley-Liss, Inc.