The quality of a mesorectal resection for rectal cancer can be graded using the total mesorectal excision (TME) score as described by Quirke. The better the resection the better the outcome. The authors are from the Dutch Colorectal Group.
Patient selection: excision of rectal cancer in middle and distal thirds
Exasm: gross pathology of resected specimen
Parameters:
(1) circumferential resection margin
(2) bulk of mesorectum
(3) “coning” towards distal margin
(4) visibility of muscularis propria
Parameter
Good (Score 3)
Moderate (Score 2)
Poor (Score 1)
circumferential resection margin
smooth and regular with defects <= 5 mm
irregular
very irregular with deep defects
bulk of mesorectum
good
moderate
little
coning
none
moderate
marked
visibility of muscularis propria
none
limited to levator muscle insertion
exposed at margin
With a “good” resection the anterior, lateral and posterior mesorectal fasciae should be intact.
A poor quality excision is considered to be an incomplete resection and is associated with a high recurrence rate (around 75%).
An intermediate or good quality excision is considered to be a complete resection and associated with a lower recurrence rate (less than 30%).
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