Pathological evidence in support of total mesorectal excision in the management of rectal cancer

BACKGROUND

Pelvic recurrence following conventional rectal resection for cancer is common. Preoperative iradiation has been shown in prospective randomized studies to halve this risk.

AIM

This multiinstitutional study aimed to assess the necesity of total mesorectal excision in rectal cancer.

PATIENTS AND METHOD

Pathological resections from 50 consecutive patients with adenocarcinoma of the rectum within 12 cm of the anal verge who underwent currative resection incorporating total mesorectal excision were examined. The resection specimen was examined by one of two pathologists. Some 50 total mesorectal excision specimens were examined following rectal excision for cancer. Some 38 had total mesorectal excision as a component of a low anterior resection and 12 with abdomino-perineal resection. "Cure" was defined as absence of metastatic disease and the excision of entire macroscopic tumor tissue with negative proximal and distal borders. TME was performed as described by Heald et al. The mesorectum was evaluated for lymph nodes and tumor deposists in three areas: deep to the tumor, in the proximal mesorectum and in the distal mesorectum.

RESULTS

Six patients had Dukes A lesions. Of 21 patients with Dukes B tumors, five had discrete foci of adenocarcinoma in the mesorectum, with no evidence of lymph node metastasis. Dukes C lesions were more heterogeneous, but 12 out of 23 patients had distinct mesorectal deposists in addition to mesorectal node involvement. Circumferential margin involvement was rare, but mesorectal tumor deposits were present in 17 of 44 patients with pT3 tumors, and 23 of 44 had mesorectal nodal involvement. No patient with a pT2 tumor had mesorectal involvement. Failure to excise the mesorectum completely has the potential to leave gross or microscopic residual disease that may in theory predispose to local failure.

CONCLUSION

Total mesorectal excision is necessary to avoid incomplete pathological evaluation of the mesorectum and understaging of rectal cancer.

Magnesium and calcium concentration in the abdominal aorta of patients deceased by ischemic heart disease

Magnesium (Mg) and calcium (Ca) concentrations were determined in the abdominal aorta of 28 patients who died by acute myocardial infarction (AMI), of 52 by ischemic heart disease (IHD) and of 26 subjects deceased by accidents or from causes other than atherosclerosis. Mg concentration in the fibrous and calcareous plaques, was significantly lower than in controls. The lowest Mg values were found in those who died by AMI. Calcium concentration, especially in the calcareous plaques, was enormous as against the controls. The four-seven times decreases of Mg/Ca ratio compared with the controls imply an alteration of the arterial wall cells. Magnesium deficit in the arterial wall probably plays a certain role in this process.

Post-cholecystectomy syndrome and magnesium deficit

The serum level of magnesium and calcium was systematically measured in patients with gallstones before and after cholecystectomy. It was found that 60 percent of the operated patients suffered of different digestive syndromes in association with magnesium deficiency, while 40 percent of patients had the same complaints in association of magnesium and calcium deficiency. When magnesium and/or magnesium plus calcium was supplemented these syndromes could be decreased significantly. In the latter case, an optimal ratio of magnesium/calcium is needed in the supplementary therapy.