Dejan Lukic

The importance of training and education in performing total mesorectal excision in rectal cancer surgery

Introduction: In the last two decades there has been a significant progress in rectal cancer surgery. Preoperative radiotherapy, the introduction of staplers and largely improved surgical techniques have greatly contributed to better treatment outcomes, primarily by reducing the frequency of early surgical complications and the rate of local recurrence. The aim of this study was to compare operative and postoperative results in the treatment of rectal cancer between the two groups of surgeons - those who are closely engaged in colorectal surgery and those who deal with these issues sporadically. Material and Methods: A retrospective study on 146 patients who underwent rectal cancer surgery at the Institute of Oncology in the period from 01.01.2008. to 31.12.2010. Patients were divided into two groups. The first group (N1 = 101) consisted of patients operated by trained colorectal surgeons, and in the second (N2 = 45) there were patients who were operated on by surgeons without training in TME. Results: Preoperative chemoradiotherapy was received by 49 (33.56%) patients. Statistically significant difference between the two groups was noted in the duration of surgery and the need for blood transfusion during surgery. Anastomotic leakage occurred in 3 patients from N1 and in 10 patients from group N2. Seven patients (4.79%) developed local recurrence after surgical treatment. Significant differences exist in local recurrence rate and anastomotic leakage rate between compared groups. Conclusion: It is necessary to continue education and training in surgery for rectal cancer to master new technologies and surgical techniques and to improve the results of surgical treatment.