Study of the Condition of Circular Resection Margin (CRM) During the Laparascopic and Open Total Mesorectal Excision (TME) Comparatively

Abstract

Study of the factors (direct development of tumor, tumor deposits, tumor emboles, lymph nodes) affecting the CRM during the total mesorectal excision assumes special importance.  High level (60-70%) of local recurrences in the patients with the positive CRM necessitates researching of the factors affecting the CRM.

Materials and methods: The research work was carried out under the examination and treatment of 103 patients diagnosed with rectal carcinoma at the Clinical Medical Center which is the base of the Surgical Diseases Department I of Azerbaijan Medical University and the private clinic “Elmed” Medical Center in 2010-2015. The patients were divided into 2 semi-groups: 1) 47 patients implemented total mesorectal excision in a laparoscopic way; 2) 56 patients implemented total mesorectal excision in an open way. The MRT examination of small pelvis, CT examination of the chest cavity and abdominal cavity, colonoscopy, appointment of the oncomarkers in blood and other methods of examination were used in the course of the research.

Result of the research: The factors like the tumor size, invasion depth, metastatic damage of the mesorectal lymph nodes, tumor emboles, tumor deposits, distance from the anus, phase of the tumor process and quality of the TME have statistical exact effect on the CRM status during the pathohistological examination of the drug made.  The CRM was positive in T3/T4 masses in 66,7% cases, in the patients with their lymph nodes damaged metastatically in 57,1% cases, in the tumors of III phase in 57,1% cases, in large tumors more than 4cm in 50% cases. 33,3% local recurrence was noted in these patients (p ).