Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands

TLDR

Total mesorectal excision (TME) has improved local control and survival in rectal cancer surgery. The study aimed to assess the nationwide impact of TME introduction and training on recurrence and survival in rectal cancer. The authors compared short‑ and long‑term outcomes of a recent TME trial with an older CRAB trial, restricting to curatively operated patients without neoadjuvant radiotherapy, adjusting for clinicopathological differences via multivariate analysis, and focusing on events within two years post‑operation. Local recurrence fell from 16 % to 9 % and overall survival improved in the TME trial, with operation type independently predicting both outcomes.

Abstract

Abstract Background Local control and survival following surgical treatment of rectal cancer have been improved by the introduction of total mesorectal excision (TME). The aim of this study was to determine the nationwide impact of the introduction and training of TME on recurrence and survival in rectal cancer. Methods Short- and long-term outcomes of a recently published trial of rectal cancer surgery (TME trial) were compared with results from an older trial (cancer recurrence and blood transfusion (CRAB) trial), in which conventional surgery was performed without quality control. Only patients who were operated on with curative intent and who did not receive neoadjuvant radiotherapy were studied. Differences in clinicopathological characteristics were corrected for by multivariate analysis. To ensure valid comparisons, only events that occurred within 2 years of operation were analysed with regard to long-term outcome. Results In the univariate analysis, a higher clinical anastomotic leak rate was found in patients following low anterior resection in the TME trial (P = 0·046), but this association was not significant in the multivariate analysis. The local recurrence rate decreased from 16 per cent in the CRAB trial to 9 per cent in the TME trial, and type of operation (conventional (CRAB trial) versus TME (TME trial)) was an independent predictor of local recurrence (P = 0·002). Type of operation was also an independent predictor of overall survival (P = 0·019); there was a higher survival rate in the TME trial. Conclusion The introduction and training of TME has led to improved long-term outcome of patients with rectal cancer in the Netherlands.