直肠癌手术中全直肠系膜切除标本的质量采用三级分级（直肠系膜、直肠系膜内和固有肌层）。本研究旨在分析全直肠系膜切除分级对生存的预后影响，并在基于人群的环境中确定直肠系膜内和固有肌层切除的危险因素。瑞典结直肠癌登记处的所有直肠癌 I-III 期患者分析了 2015-2019 年诊断、距肛缘 ≤ 10 厘米、接受全直肠系膜切除术的患者。检索临床、手术和病理数据并分析以下主要结果：局部和远处复发以及总体和相对生存率；次要结局是全直肠系膜切除分级（系膜内或固有肌层切除）的危险因素。值得注意的是，术后死亡 < 30 天或 90 天内复发是生存和复发分析的排除标准。随访时间少于 3 年的无复发患者以及缺乏复发数据的患者也被排除在复发分析之外。总体而言，在研究间隔期间接受治疗的 7979 名患者中，1499 名患者符合复发条件，2441 名患者符合生存条件，2441 名患者符合生存条件。对 2476 名患者进行了危险因素分析，其中 75% 分级为直肠系膜，17% 分级为直肠内分级，8% 分级为固有肌层。中位生存期随访时间为 42 (1-77) 个月。在多变量分析中，最差的全直肠系膜切除分级（固有肌层切除）是局部复发的独立危险因素（HR 2.73，95% c.i. 1.07 至 7.0，P = 0.036）。全直肠系膜切除分级对远处复发或生存没有影响。女性、肿瘤水平<5 cm、腹会阴切除、微创手术（腹腔镜和机器人）、失血量高、手术时间长和术中穿孔是全直肠系膜切除分级较差（直肠内和/或固有肌层切除）的独立危险因素）在多变量分析中。固有肌层切除会增加局部复发的风险，但似乎不会影响远处复发或生存。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

The quality of the total mesorectal excision specimen in rectal cancer surgery is assessed with a three-tier grade (mesorectal, intramesorectal and muscularis propria). This study aimed to analyse the prognostic impact of the total mesorectal excision grade on survival, and to identify risk factors for intramesorectal and muscularis propria resection in a population-based setting.All patients in the Swedish Colorectal Cancer Registry with rectal cancer stage I-III ≤ 10 cm from the anal verge, diagnosed 2015-2019, undergoing total mesorectal excision were analysed. Clinical, surgical and pathological data were retrieved and analysed for the following primary outcomes: local and distant recurrence and overall and relative survival; secondary outcomes were risk factors for total mesorectal excision grading (intramesorectal or muscularis propria resection). Of note, postoperative death < 30 days or recurrence within 90 days were exclusion criteria for survival and recurrence analysis. Recurrence-free patients with less than 3 years follow-up, and patients lacking data regarding recurrence, were also excluded from recurrence analyses.Overall, of 7979 patients treated during the study interval, 1499 patients were eligible for recurrence, 2441 patients for survival and 2476 patients for risk-factor analyses, of which 75% were graded mesorectal, 17% intramesorectal and 8% muscularis propria. Median follow-up for survival was 42 (1-77) months. The worst total mesorectal excision grading (muscularis propria resection) was an independent risk factor for local recurrence in multivariable analysis (HR 2.73, 95% c.i. 1.07 to 7.0, P = 0.036). Total mesorectal excision grade had no impact on distant recurrence or survival. Female sex, tumour level <5 cm, abdominoperineal resection, minimally invasive surgery (laparoscopic and robotic), high blood loss, long duration of surgery and intraoperative perforation were independent risk factors for worse total mesorectal excision grading (intramesorectal and/or muscularis propria resection) in multivariable analyses.Muscularis propria resection increases the risk of local recurrence but does not seem to affect distant recurrence or survival.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.