Objective: To find out whether total mesorectal excision (TME) technique alone or combined with preoperative radiotherapy reduces local recurrence rate and improves survival.
Design: Partly retrospective (the first period), partly prospective (the second period) study.
Setting: University hospital, Helsinki, Finland.
Subjects: 144 patients between 1980 and 1990 and 61 patients between 1991 and 1997 with rectal cancer, who underwent major curative surgery.
Interventions: A conventional surgical technique was used during the first period and TME alone or combined with preoperative radiotherapy when appropriate during the second period.
Main outcome measures: Postoperative morbidity and mortality, local recurrence rate, and 5-year survival.
Results: After anterior resection 4/76 of the patients (5%) during the first period and 8/43 (19%) during the second period developed anastomotic leaks. Operative 30-day mortality was 1% (n = 1) and 0, respectively. Actuarial local recurrence rate was 17% in the first period and 9% in the second period. Actuarial crude 5-year survival improved from 55% to 78% and cancer-specific survival from 67% to 86% between the two study periods.
Conclusions: Despite an increased number of anastomotic complications TME is safe. Refinement of the surgical technique together with preoperative radiotherapy yields lower local recurrence rates and an improved survival compared with conventional surgery alone.