Total mesorectal excision

Total mesorectal excision (TME) is a surgical procedure used in the treatment of rectal cancer. It involves the removal of the entire mesorectum, which is the fatty tissue surrounding the rectum. This procedure is considered the gold standard for surgical treatment of rectal cancer due to its high success rate in preventing local recurrence of the disease.

History

The concept of TME was first introduced by Richard Heald in the 1980s. Heald's work revolutionized the surgical approach to rectal cancer, significantly reducing local recurrence rates and improving survival outcomes.

Procedure

During a TME, the surgeon removes the entire mesorectum, ensuring that all potential cancerous tissue is removed. This is achieved by following the plane of dissection along the mesorectal fascia, a thin layer of connective tissue that envelops the mesorectum.

The procedure can be performed either as an open surgery or using minimally invasive techniques such as laparoscopic surgery or robot-assisted surgery. The choice of technique depends on various factors, including the location and stage of the cancer, the patient's overall health, and the surgeon's expertise.

Outcomes

Studies have shown that TME results in lower local recurrence rates and better survival outcomes compared to other surgical techniques for rectal cancer. However, the procedure is technically demanding and requires a high level of surgical skill. Complications can include damage to the nerves controlling urinary and sexual function, which are located close to the rectum.

See also

• Rectal cancer
• Richard Heald
• Laparoscopic surgery
• Robot-assisted surgery