Total mesorectal excision (TME)

Sharp dissection in the areolar plane between visceral fascial envelope surrounding the mesorectum and the parietal fascia overlying the pelvic wall structures, with removal of draining lymph nodes, of the rectum.

Total meso rectal excision defined as complete resection of the visceral meso rectum with pelvic nerve preservation is considered the primary reason for decreasing the local recurrence rate from 25% to less than 5-10%,  in patients  with medically operable locally advanced rectal cancer.

The procedure is referred to as sharp mesorectal.

It decreases the likelihood of a positive circumferential margin.

TME decreases local recurrence and improves survival.

TME in conjunction with autonomic nerve preservation has led to decrease postoperative genitourinary dysfunction.

Extirpation of locally advanced lesions T3/4 or N1/2 is difficult because of the close confines of the bony pelvis limit access to deep tumors to allow clear circumferential margins while avoiding injury to autonomic nerves that can affect bladder and sexual function.

Facilitates pelvic autonomic nerve preservation and decreases bladder incontinence and sexual impairment.

Pathologic grading of adequacy of rectal cancer resection into the mesorectal plane is associated with a good outcome, intra-mesorectal plane, with a moderate result, and the muscularis propria plane with a poor surgical result.

Negative surgical margins can be achieved in 96% of cases.

Negative radial margins reduces risk of pelvic recurrence, and such procedures reported to have local failure rate as low as 3% and overall survival at 5 years of up to 80%.

Total mesorectal excision (TME) is a standard technique for treatment of colorectal cancer.

TME has become the primary treatment for rectal cancer.

A significant length of the bowel around the tumor is removed, as is the surrounding tissue up to the plane between the mesorectum and the presacral fascia.

A complete mesocolic excision is based on the pattern of the lymph node metastases and comprises dissection in the mesocolic plane, a sufficient bowel resection of a minimum of 10 cm proximal and distal of the tumor and central vascular ligation to ensure a lymph node dissection around the superior mesenteric vessels.

Dissection along this plane facilitates a dissection and preserves the sacral vessels and hypogastric nerves.

While it, may be possible to rejoin the two ends of the colon, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of perforation or leakage.

For right colon resection complete mesocolic excision is more challenging than conventional resections because of the complex vascular anatomy of the right colon.

Complete mesocolic excision of the. right side of colon cancer significantly lowers the risk of recurrence.

TME results in a lower recurrence rate in rectal cancers than traditional approaches and a lower rate of permanent colostomy.

There is no evidence of increased risk of urinary incontinence or sexual dysfunction.

Complete mesocolic excision surgery comprises three components: the specimen is removed in the mesocolic plane ensuring that the mesocolic fascia and peritoneum remain intact, supplying blood vessels should be ligated at their origin, and sufficient length of the colon should be removed.

Integrity of the measure: plane results in a 15% improvement in five-year overall survival, increasing is it 27% on stage three disease.

There is no good evidence that extending the length of colon resection 10 cm beyond the tumor offers any oncologic advantage.

Complete mesocolic excision for colon cancer has lead to a reduction in local recurrence (from 6.5% to 3.6%) and improvement in cancer-related 5-year survival (from 82.1% to 89.1%) over a 24-year period.

Laparoscopic lower anterior resection allows for precise rectal mobilization and nerve sparing excision and meta-analyses show short term postoperative benefits versus open surgery, including reduced blood transfusion requirements, shorter postoperative ileus, decreased length of hospital stay, less narcotic use, and better physical functioning scores.
Oncological and survival quality outcomes are similar between laparoscopic and open surgical groups for locally advanced rectal cancer.
Minimally invasive rectal cancer surgery should be performed by experienced surgeons and sholldvexclude high-risk lesions such as those that are T4 or with a threatened mesorectal margin.

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