Impact of mesorectal status on local recurrence and survival in patients with rectal cancer

Abstract:

The main aim of this paper is to evaluate, by reviewing the most pertinent literature, both the prognostic impact of the mesorectum status in patients with cancer of the rectum and the rationale for mesorectal excision. Recent literature has been considered with special reference to the outcomes of the mesorectal surgical treatment on the relapse rate and survival. The infiltration of the mesorectum adversely affects the prognosis of the patient after a curative operation, whereas it is doubtful whether its excision per se is able to improve the prognosis. Therefore, involvement of the mesorectum may be considered to be an important indicator of already advanced and aggressive malignancy more than the true cause for the relapse. In fact, lately, some authors have pointed out that the extent of the mesorectal excision should be tailored to the specific case in order to achieve adequate and safe surgical margins and have enough prognostic information. Indiscriminate total mesorectal excision in all rectal tumours is not supported by data showing a prognostic improvement. Consequently, surgical management should be carefully planned considering the potential risks and the complications affecting this procedure.