Total mesorectal excision in rectal cancer resection

Despite the routine use of adjuvant chemoradiation for Stages II-III curatively resected rectal cancer, a significant percentage of patients ultimately fail locally and/or distally. Recognition of the importance of lateral, or circumferential, margins of resection has changed the surgeon's approach to oncologic resection of the rectum. The concept of total mesorectal excision (TME) is based upon the principle of resecting as an intact unit the rectum together with its lymphovascular drainage contained within the fascia propria. The widespread use of TME has been associated with a reduction in the incidence of local recurrence in large clinical series in the United States and Europe, thereby calling into question traditional indications for adjuvant therapy. Current efforts are directed at further defining the pattern of rectal cancer spread and identifying the subset of locally advanced rectal cancer patients that may be treated with a TME rectal cancer resection alone.