Articole originale Jurnalul de Chirurgie, Iasi, 2006, Vol. I1, Nr. 2 [ISSN 1584 – 9341] 168 MULTIDISCIPLINARY MANAGEMENT OF RECTAL CANCER – A RETROSPECTIVE STUDY – V. Scripcariu 1 , Elena Dajbog 1 , I. Radu 1 , C. Dragomir 1 , D. Ferariu 2 , I. Bild 3 , Elena Albulescu 3 , L. Miron 3 1 Third Surgical Clinic, “St. Spiridon” University Hospital, Iaşi, Romania Centre of Research in Surgical Oncology and Training in General Surgery 2 Department of Pathology, “St. Spiridon” University Hospital, Iaşi, Romania 3 Department of Clinical Oncology, “St. Spiridon” University Hospital, Iaşi, Romania MULTIDISCIPLINARY MANAGEMENT OF RECTAL CANCER – A RETROSPECTIVE STUDY – (Abstract): Background: The procedure of low or very low anterior resection of the rectum with total mesorectal excision (TME) it is now widely accepted for tumours of the middle and lower third of the rectum. It has become the gold standard for the treatment of cancer of the rectum, except where the tumor is close to or is involving the anal sphincter complex. Patients and methods: A retrospective study on 120 patients diagnosed with colorectal cancer and operated on between 2000 and 2004 was carried out. There were 120 anterior resection of the rectum, in 34 cases the total mesorectal excision has been performed and in 11 cases a very low anterior resection was made. All 45 cases where total mesorectal excision was made, had undertaken preoperative radiotherapy, surgery being performed after 4 to 6 weeks from the last session of radiotherapy. Results: The overall operative morbidity rate was 16.10% in direct relation with the distal limit of dissection. Postoperative complications that we note: anastomotic leakages, recto-vaginal fistulas, evisceration, peritonitis, occlusion, urinary dysfunctions. Conclusions: For the total mesorectal excision to be effective an early diagnosis is necessary, and a tumor which is not local invasive, the use of preoperative radiotherapy decreasing the local recurrence. KEY WORDS: RECTAL CANCER, RADIOTHERAPY, TOTAL MESORECTAL EXCISION Correspondence to: Viorel Scripcariu, MD, PhD, Third Unit of Surgery, Centre of Research in Surgical Oncology, “St. Spiridon” Hospital, Iaşi, Bd. Independenţei nr. 1, Iaşi, 700111, Romania; e-mail: vscripcariu@gmail.com Tel. +40722389524. * INTRODUCTION The real problem of the rectal cancer treatment is represented by the local recurrences which are difficult to treat [1]. A high incidence of local recurrence, 15-45%, was reported after conventional surgery, in which blunt dissection of the rectal fascia often fails to remove the entire tumoral tissue [2]. The current surgical management of the rectal cancer is based on new, improved rectal anatomy elements (mesorectum), revealed to the surgeons on the last 20 years. This combined with an accurate preoperative assessment of the cancer and radiotherapy had increased the patient’s outcome [3]. The operation of anterior resection of the rectum with total mesorectal excision (TME) has become the gold standard for the rectal cancer treatment, except where the tumour is close or involves the anal sphincter complex. Tripartite Consensus Conference held in Washington, DC, in 1999 defined TME as being the complete excision of visceral mesorectal tissue to the level of the levators [4]. Although controversy still exists around the role of TME in tumours of the upper rectum, it is now widely accepted for tumours of the middle and lower third. The TME * received date: 19.04.2006 accepted date: 25.04.2006