Total mesorectal excision (TME) is a standard surgical technique for treatment of

rectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel ...

, first described in 1982 by Professor Bill Heald at the UK's

Basingstoke Basingstoke ( ) is the largest town in the county of Hampshire. It is situated in south-central England and lies across a valley at the source of the River Loddon, at the far western edge of The North Downs. It is located north-east of Southa ...

District Hospital. It is a precise dissection of the mesorectal envelope comprising rectum containing the tumour together with all the surrounding fatty tissue and the sheet of tissue that contains lymph nodes and blood vessels. Dissection is along the avascular alveolar plane between the

presacral In human anatomy, the presacral space is inside the pelvis, behind the rectum and in front of the coccyx and sacrum. Normally it is empty, or it contains a pocket of fat. It is usually covered by sigmoid colon. Clinical significance The presacral ...

and mesorectal fascia, described as

holy plane The presacral fascia lines the anterior aspect of the sacrum, enclosing the sacral vessels and nerves. It continues anteriorly as the pelvic parietal fascia, covering the entire pelvic cavity. The presacral fascia is limited postero-inferiorly, a ...

(Heald's "

"). Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and

hypogastric nerve The hypogastric nerve is the nerve that transitions between the superior hypogastric plexus and the inferior hypogastric plexus. The hypogastric nerve enters the sympathetic chain at T12- L3. Structure The hypogastric nerve begins where the su ...

s and is a

sphincter A sphincter is a circular muscle that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning. Sphincters are found in many animals. There are over 60 types in the hum ...

-sparing resection and decreases permanent

stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...

rates. It is possible to rejoin the two ends of the colon; however, most patients require a temporary

ileostomy Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy an ...

pouch to bypass the colon, allowing it to heal with less risk of infection, perforation or leakage. TME has become the "gold standard" treatment for rectal cancer Worldwide. The operation can be done by

open Open or OPEN may refer to: Music * Open (band), Australian pop/rock band * The Open (band), English indie rock band * ''Open'' (Blues Image album), 1969 * ''Open'' (Gotthard album), 1999 * ''Open'' (Cowboy Junkies album), 2001 * ''Open'' (YF ...

surgery,

laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medlin ...

or Robot-assisted. For lower down tumours in the middle and lower third of the rectum a new procedure has been developed known as Transanal-Total Mesorectal Excision (TaTME). Instead of the dissection via the abdomen TaTME combines an abdominal and transanal endoscopic approach (endoscopic instruments are inserted into the anus) allowing easier dissection of the most difficult part of the surgery deep down in the pelvis (particularly in male patients or patients with visceral obesity or a narrow pelvis). The perceived benefits of this technique may include ease of procedure due to better views, decreased operative time and reduced complications. An occasional side effect of the operation is the formation and tangling of fibrous bands from near the site of the operation with other parts of the bowel. These can lead to bowel infarction if not operated on. TME results in a lower recurrence rate than traditional approaches and a lower rate of permanent

colostomy A colostomy is an opening ( stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it int ...

. Postoperative recuperation is somewhat increased over competing methods. When practiced with diligent attention to anatomy there is no evidence of increased risk of urinary incontinence or sexual dysfunction. However, there can be partial fecal incontinence and/or "clustering" – a series of urgent trips to the toilet separated by a few minutes, each trip producing only a very small yield. Depending on the

staging Staging may refer to: Computing * Staging (cloud computing), a process used to assemble, test, and review a new solution before it is moved into production and the existing solution is decommissioned * Staging (data), intermediately storing data b ...

, size and location of the tumour,

neoadjuvant Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. One example is neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate. Neoadjuvant therapy aims to reduce the size o ...

radiotherapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

often combined with

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

may be used to shrink the tumour prior to surgery and prevent further

spread Spread may refer to: Places * Spread, West Virginia Arts, entertainment, and media * ''Spread'' (film), a 2009 film. * ''$pread'', a quarterly magazine by and for sex workers * "Spread", a song by OutKast from their 2003 album ''Speakerboxxx/T ...

Adjuvant In pharmacology, an adjuvant is a drug or other substance, or a combination of substances, that is used to increase the efficacy or potency of certain drugs. Specifically, the term can refer to: * Adjuvant therapy in cancer management * Analgesic ...

chemotherapy may also be used post-surgery to prevent further disease spread

References

Surgical removal procedures Digestive system surgery {{Surgery-stub