A study on factors influencing the quality of total mesorectal excision

Robin Prabhu, I (2014) A study on factors influencing the quality of total mesorectal excision. Masters thesis, Stanley Medical College, Chennai.

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Abstract

BACKGROUND: Total mesorectal excision (TME) has become the standard of care for rectal cancer. Incomplete TME has been found lead to local recurrence. The factors which impact the TME have been scarcely studied. In this study we plan to investigate those factors which affect the quality of TME. AIMS & OBJECTIVES: 1. Determine the patients undergoing surgery for rectal malignancy with adequate total mesorectal excision, and 2. Identify the patient, disease and surgery related factors which influenced the quality of mesorectal excision. METHODS: Data of patients undergoing resectional surgery for adenocarcinoma of the rectum were entered into the database. This data included age, sex, BMI, distance of tumor from anal verge, pathological tumor stage, use of neo-adjuvant therapy, surgical modality, duration of surgery, presence of intra-op complications and type of dissection technique. The specimen after surgery was examined both by the surgeon and the pathologist. It was classified either as optimal TME or sub-optimal TME. Statistical analysis was done using chi-square test for categorical variables and ANOVA for continuous variables. RESULTS: Of a total 50 patient, 38 patients were found to have grade 1 TME, 8 with grade 2 TME and 4 with grade 3 TME. Significant association (p<0.05) was found between Pathological tumour category T4, presence of intra-operative complications, surgery lasting longer than 240 mins and use of monopolar or blunt dissection. No significance was seen with age of patient, gender, BMI of the patient, distance of tumor from anal verge, type of surgical approach or neo-adjuvant therapy, CONCLUSION: Negative impact on TME was found with distinctive disease and surgery related factors.

Item Type: Thesis (Masters)
Uncontrolled Keywords: TME ; Rectal carcinoma ; mesorectum ; dissection ; Low anterior resection ; Abdomino-perineal Resection ; recurrence ; quality.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jul 2018 03:44
Last Modified: 05 Jul 2018 17:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/8637

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