p.6
Total Mesorectal Excision (TME) Overview
How has the introduction of TME by Heald impacted local recurrence rates in rectal cancer?
Heald's introduction of TME has led to a substantial reduction in the local recurrence rate from 30% to less than 10%.
p.2
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What surgical method is recommended for mid-rectal cancer according to most studies?
Total Mesorectal Excision (TME) with dissection down to the pelvic floor.
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Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What is the mean length of the distal resection margin in the PME group?
The mean length of the distal resection margin in the PME group was 3.3 cm.
p.2
Turkish Colorectal Cancer Database Study
What database was utilized for the study on mid-rectal cancer surgeries?
The Turkish Society of Colon and Rectal Surgery (TSCRS) colorectal cancer database.
p.5
Postoperative Complications and Morbidity
What was the mean hospital stay for patients in the PME group compared to the TME group?
The mean hospital stay was 7.3 days for the PME group and 8.1 days for the TME group (p=0.13).
What was declared by the authors regarding financial support for the study?
The authors declared that this study received no financial support.
p.5
Clinical and Pathological Outcomes Comparison
How did the pN stage compare between the PME and TME groups?
In the PME group, 58.3% were pN0 compared to 68.7% in the TME group (p=0.45).
p.1
Short-term Outcomes of PME vs. TME
What conclusion did the study reach regarding PME in mid-rectal cancer?
PME does not compromise surgical resection margins or short-term outcomes in patients with mid-rectal cancer.
p.3
Clinical and Pathological Outcomes Comparison
What was the significant finding regarding the cTNM stage between the PME and TME groups?
cTNM stage was significantly higher in the TME group (p=0.016)
p.6
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What does the study suggest about the risk of distal resection margin positivity in PME compared to TME for mid-rectal cancer?
The study suggests that PME neither increases the risk of distal resection margin positivity nor radial margin positivity compared to TME.
p.6
Clinical and Pathological Outcomes Comparison
What did the recent study by Guedj et al. reveal about lymph node positivity in patients undergoing PME after neoadjuvant chemoradiotherapy?
The study reported that none of the 98 examined nodes were positive in patients undergoing PME after neoadjuvant chemoradiotherapy.
p.2
Surgical Margin Positivity in Rectal Cancer
What were the primary outcomes assessed in the study?
The positivity of the distal and radial resection margins.
p.8
Total Mesorectal Excision (TME) Overview
What did the study suggest about the quality of surgical procedure in PME?
The study demonstrated that PME does not impair the quality of the surgical procedure, with complete mesorectal excision achieved in 86% of PME patients.
p.8
Neoadjuvant Chemoradiotherapy Effects
What is suggested about the preservation of the lower rectum with PME?
Conservation of the lower rectum with PME can potentially decrease the risk of low anterior resection syndrome.
p.4
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What was the rate of diverting stoma formation in the PME group compared to the TME group?
The rate of diverting stoma formation was 58.3% in the PME group and 85.8% in the TME group.
p.4
Clinical and Pathological Outcomes Comparison
What was the comparison of the mean lengths of distal resection margins between the PME and TME groups?
The mean lengths of the distal resection margins were comparable between the PME group (3.3±1.4 cm) and the TME group (3.3±1.6 cm).
p.6
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What is the rationale behind adopting PME for upper rectal cancer?
The rationale is to prioritize functional outcomes while ensuring oncological adequacy, especially in the era of neoadjuvant chemoradiation.
p.5
Short-term Outcomes of PME vs. TME
How did PME compare to TME in terms of lymph nodes harvested?
PME showed no significant difference in the number of lymph nodes harvested compared to TME (OR: 1.28, 95% CI: -1.62-7.70, p=0.20).
p.1
Total Mesorectal Excision (TME) Overview
What is the rationale behind completely excising the mesorectum in rectal cancer surgery?
To address local recurrences due to distal extramural cancer spread, such as lymph node metastasis and mesorectal tumor deposits.
p.4
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What were the mean operative times for the PME and TME groups?
The mean operative time was 187.3±68.2 minutes for the PME group and 214±82.3 minutes for the TME group.
p.4
Postoperative Complications and Morbidity
Were there substantial differences in the rates of surgical site infections between the PME and TME groups?
There were no substantial differences in the rates of surgical site infections between the PME and TME groups.
p.6
Postoperative Complications and Morbidity
What are some of the morbidities associated with TME?
TME is associated with a high incidence of morbidity, including anorectal and urogenital dysfunctions due to extensive pelvic dissection.
p.8
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What percentage of mid-rectal cancers showed distal viable cancer spread in the study involving 124 patients?
Only three (2.4%) mid-rectal cancers showed distal viable cancer spread.
p.2
Statistical Analysis Methods Used
What statistical methods were used to analyze the data in the study?
Univariate analyses followed by multivariate analysis to determine independent predictors of study outcomes.
p.8
Short-term Outcomes of PME vs. TME
What was the rate of stoma creation in the PME group compared to the TME group?
The rate of stoma creation was substantially lower in the PME group at 58.3% compared to 85.8% in the TME group.
p.1
Short-term Outcomes of PME vs. TME
How many patients were included in the study comparing PME and TME for mid-rectal cancer?
158 patients were included in the study.
p.4
Postoperative Complications and Morbidity
What were the postoperative morbidity rates for anastomotic leak in the PME and TME groups?
The rates of anastomotic leak were 4.2% in the PME group and 8.9% in the TME group.
p.2
Clinical and Pathological Outcomes Comparison
What was the aim of the study regarding PME and TME?
To investigate the impact of PME versus TME on surgical margins and short-term perioperative outcomes in patients with mid-rectal cancer.
p.8
Postoperative Complications and Morbidity
What was the postoperative complication rate in the TME group compared to the PME group?
The postoperative complication rate was higher in the TME group at 21.4% compared to 14.5% in the PME group.
p.5
Postoperative Complications and Morbidity
What were the postoperative complication rates for red blood cell transfusion in the PME and TME groups?
In the PME group, 29.2% required red blood cell transfusion compared to 18.7% in the TME group (p=0.37).
p.4
Postoperative Complications and Morbidity
What was the mean hospital stay for the PME group compared to the TME group?
The mean hospital stay was 7.3±4.9 days in the PME group and 8.1±5.0 days in the TME group.
p.9
Turkish Colorectal Cancer Database Study
Who contributed data to the Turkish Colorectal Cancer Database Study?
Dr. Cihangir Akyol, Dr. Ayhan Kuzu, Dr. Emre Balık, Dr. Dursun Buğra, Dr. Tahsin Çolak, Dr. Feza Karakayalı, Dr. Sezai Leventoğlu, Dr. Mustafa Öncel, Dr. Ersin Öztürk, Dr. Selman Sökmen, Dr. İlker Sücüllü, Dr. Uğur Sungurtekin, Dr. Aras Emre Canda, and Dr. Cem Terzi.
p.2
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What recent research finding suggests a viable option for mid-rectal cancer treatment?
Partial Mesorectal Excision (PME) with a shorter distal resection margin could preserve a longer rectal stump and ensure better rectal function.
p.8
Surgical Margin Positivity in Rectal Cancer
How did the rate of tumoral involvement in the distal resection margin compare between PME and TME groups?
The rate of tumoral involvement was extremely low and similar between the groups, with 4.2% in the PME group and 2.2% in the TME group.
p.1
Total Mesorectal Excision (TME) Overview
What surgical technique has been widely adopted as the standard for all rectal cancers since its introduction by Heald?
Total mesorectal excision (TME)
p.1
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What was the aim of the study regarding partial mesorectal excision (PME) in mid-rectal cancer?
To assess the short-term clinicopathological outcomes of PME in mid-rectal cancer.
p.1
Short-term Outcomes of PME vs. TME
Did the study find any differences in nodal harvest between PME and TME groups?
No differences were observed in nodal harvest (18.6±8.5 in PME vs. 15.6±9.2 in TME).
p.4
Clinical and Pathological Outcomes Comparison
How many lymph nodes were harvested on average in the PME group compared to the TME group?
The mean numbers of lymph nodes harvested were 18.6±8.5 in the PME group and 15.6±9.2 in the TME group.
p.9
Clinical and Pathological Outcomes Comparison
What is the main focus of the Turkish Colorectal Cancer Database Study?
To analyze clinical and pathological outcomes related to colorectal cancer.
p.1
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What is the current recommendation for the distal resection margin for upper- and mid-rectal cancers?
Current guidelines recommend partial mesorectal excision (PME) for upper rectal cancer, involving division of the mesorectum 5 cm below the tumor level.
p.5
Postoperative Complications and Morbidity
What was the rate of tumor perforation in the PME group?
The rate of tumor perforation in the PME group was 4.2%.
p.5
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
What were the results of the multivariable logistic regression analyses comparing PME and TME regarding distal resection margins?
PME did not significantly increase the risk of positivity for distal resection margins (OR: 0.77, 95% CI: 0.02-19.08, p=0.88).
p.5
Short-term Outcomes of PME vs. TME
What was the rate of anastomotic leaks in the PME group compared to the TME group?
The likelihood of an anastomotic leak was not significantly different between PME and TME (OR: 0.3, 95% CI: 0.01-2.60, p=0.33).
p.5
Clinical and Pathological Outcomes Comparison
What was the percentage of complete mesorectal excision in the PME group?
In the PME group, 86.4% had complete mesorectal excision.
p.3
Neoadjuvant Chemoradiotherapy Effects
What was the significant difference in neoadjuvant treatment usage between the PME and TME groups?
37.5% in PME group vs. 87.3% in TME group (p<0.001)
p.4
Partial Mesorectal Excision (PME) in Upper Rectal Cancer
How did the mean distance of the anastomosis from the anal verge compare between the PME and TME groups?
The mean distance of the anastomosis from the anal verge was longer in the PME group (5.2±1.5 cm) compared to the TME group (3.7±1.1 cm).
p.8
Future Research Directions and Limitations
What is a major limitation of the study regarding the data used?
The retrospective nature of the data obtained from the prospectively maintained national database is a major limitation.
p.1
Short-term Outcomes of PME vs. TME
What significant difference was observed between the PME and TME groups in the study?
Stoma creation was significantly different, with 58.3% in PME vs. 85.8% in TME (p=0.004).
