Value of Mesorectum Excision in Cancer Rectum

Background: Total Mesorectal Excision (TME) is the standard for rectal cancer with the pathological quality of the excised specimen being a critical prognostic factor. Suboptimal TME can compromise local control and survival. Aim: This study aimed to assess the pathological quality of TME in patients undergoing surgery for mid to low rectal adenocarcinoma and to correlate these findings with locoregional recurrence rates, sphincter preservation and short-term disease-free survival. Patients and methods: One hundred twenty consecutive patients undergoing TME were included. Mesorectal specimens were pathologically assessed as complete, nearly complete, or incomplete. Data on neoadjuvant therapy, surgical approach and outcomes were prospectively collected. Clinicopathological data, neoadjuvant therapy and surgical approach were collected. Patients were prospectively followed for locoregional recurrence, distant metastasis, sphincter preservation rates, and disease-free survival at 12 months. Results: A complete TME was achieved in 80% (96/120) of patients, nearly complete in 15% (18/120), and incomplete in 5% (6/120). Locoregional recurrence at twelve months was significantly lower with complete TME (2.1%) compared to nearly complete (11.1%) or incomplete (33.3%) excisions (p<0.001). Sphincter preservation was higher with complete TME (75% vs. 60% nearly complete, 30% incomplete; p=0.002). Disease-free survival at 12 months was significantly higher in the complete TME group (95.8%) versus nearly complete (83.3%) and incomplete (66.7%) groups (p<0.001). Conclusion: The quality of TME is an independent prognostic factor directly impacting locoregional recurrence and survival. Achieving a complete mesorectal excision is a primary surgical goal, associated with superior oncological outcomes and higher sphincter preservation.