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Fundamentals of Rectal Cancer SurgeryFundamentals of Rectal Cancer Surgery

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Tailored Mesorectal Excision (TME)

Tailored Mesorectal Excision (TME) is a topic covered in the Fundamentals of Rectal Cancer Surgery.

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ASCRS U Education Portal is the one-stop place for all things related to colorectal surgery. Provided by the American Society of Colon & Rectal Surgeons. Powered by Unbound Medicine. Explore these free sample topics:

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A tailored mesorectal excision (also referred to as a partial mesorectal excision or tumor-specific mesorectal excision) can be employed for cancers in the upper and upper-mid rectum. The rationale for a 5-cm distal margin is based upon data showing longitudinal spread within the tubular lymphatics and lymph nodes of the rectum extending from 2 to 4 cm distal to the lesion.[1],[2] For upper rectal cancers, a distal mesorectal margin of 5 cm should be obtained, including rectum and mesorectum. However, for lesions in lower-mid and distal rectum, a total mesorectal excision is performed that includes all lymphatics and lymph nodes associated with cancer in this location. For lower cancers following neoadjuvant therapy, a distal rectal wall margin as small as 1 cm can be adequate in order to achieve sphincter preservation with good oncologic control.[3],[4],[5]

Total mesorectal excision is associated with high incidence of anastomotic leak that in part is due to devascularization of the distal “bared” rectal muscular tube used to construct a low colorectal or colo-anal anastomosis. Partial mesorectal excision avoids devascularization of the distal rectal tube and is supported by histologic examination of extent of lymphatic cancer spread in the mesorectum distal to the cancer. Partial mesorectal excision follows the same dissection planes as total mesorectal excision except the mesorectum is divided perpendicular to the axis of the bowel when an adequate distal mesorectal margin has been assured, 5 cm distal to the distal end of the tumor. The bowel is divided at the same level as the mesorectal division (Figure 7.1).

To avoid implantation of viable cancer cells in the anastomosis, some surgeons irrigate the rectal lumen with a tumoricidal agent (e.g., sterile water, Betadine solution). This can be done trans-anally prior to stapling and dividing the rectum. One technique for doing this is to clamp the rectum distal to the cancer and superior to the point of transection. Then the irrigation is performed, followed by dividing the rectum distal to the clamp.

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A tailored mesorectal excision (also referred to as a partial mesorectal excision or tumor-specific mesorectal excision) can be employed for cancers in the upper and upper-mid rectum. The rationale for a 5-cm distal margin is based upon data showing longitudinal spread within the tubular lymphatics and lymph nodes of the rectum extending from 2 to 4 cm distal to the lesion.[1],[2] For upper rectal cancers, a distal mesorectal margin of 5 cm should be obtained, including rectum and mesorectum. However, for lesions in lower-mid and distal rectum, a total mesorectal excision is performed that includes all lymphatics and lymph nodes associated with cancer in this location. For lower cancers following neoadjuvant therapy, a distal rectal wall margin as small as 1 cm can be adequate in order to achieve sphincter preservation with good oncologic control.[3],[4],[5]

Total mesorectal excision is associated with high incidence of anastomotic leak that in part is due to devascularization of the distal “bared” rectal muscular tube used to construct a low colorectal or colo-anal anastomosis. Partial mesorectal excision avoids devascularization of the distal rectal tube and is supported by histologic examination of extent of lymphatic cancer spread in the mesorectum distal to the cancer. Partial mesorectal excision follows the same dissection planes as total mesorectal excision except the mesorectum is divided perpendicular to the axis of the bowel when an adequate distal mesorectal margin has been assured, 5 cm distal to the distal end of the tumor. The bowel is divided at the same level as the mesorectal division (Figure 7.1).

To avoid implantation of viable cancer cells in the anastomosis, some surgeons irrigate the rectal lumen with a tumoricidal agent (e.g., sterile water, Betadine solution). This can be done trans-anally prior to stapling and dividing the rectum. One technique for doing this is to clamp the rectum distal to the cancer and superior to the point of transection. Then the irrigation is performed, followed by dividing the rectum distal to the clamp.

Vimeo video.

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Last updated: November 22, 2021

Citation

"Tailored Mesorectal Excision (TME)." Fundamentals of Rectal Cancer Surgery, 2021. ASCRS U, www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831017/all/Tailored Mesorectal Excision (TME).
Tailored Mesorectal Excision (TME). Fundamentals of Rectal Cancer Surgery. 2021. https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831017/all/Tailored Mesorectal Excision (TME). Accessed March 22, 2023.
Tailored Mesorectal Excision (TME). (2021). In Fundamentals of Rectal Cancer Surgery https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831017/all/Tailored Mesorectal Excision (TME)
Tailored Mesorectal Excision (TME) [Internet]. In: Fundamentals of Rectal Cancer Surgery. ; 2021. [cited 2023 March 22]. Available from: https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831017/all/Tailored Mesorectal Excision (TME).
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tailored Mesorectal Excision (TME) ID - 2831017 Y1 - 2021/11/22/ BT - Fundamentals of Rectal Cancer Surgery UR - https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831017/all/Tailored Mesorectal Excision (TME) DB - ASCRS U DP - Unbound Medicine ER -
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Grapherence® [↑5]
    • Fundamentals of Rectal Cancer Surgery
    • Background
    • Rectal Anatomy
    • Rectal Cancer Biology and Hereditary Cancer Syndromes
    • Rationale for Multi-Modality Therapy
    • Preoperative Issues
    • Preoperative Staging
    • Role of Tumor Board
    • Indications for Preoperative Neoadjuvant Therapy
    • Local Excision
    • Indications for LAR Versus Intersphincteric Resection Versus APR
    • Indications for Extended Resection
    • Preoperative Preparation
    • Interoperative
    • Patient Positioning and Equipment for Rectal Cancer Surgery
    • Inferior Mesenteric Artery
    • Inferior Mesenteric Vein (IMV)
    • Splenic Flexure Mobilization
    • Surgical Techniques for Length
    • Technique of Total Mesorectal Excision (TME)
    • Tailored Mesorectal Excision (TME)
    • Bowel Transection and Anastomosis
    • Indications for Fecal Diversion
    • Abdominoperineal Resection
    • Standardized Operative Report
    • Management of Intraoperative Vascular and Urinary Complications
    • Postoperative Issues
    • Rectal Cancer Pathology Assessment
    • Adjuvant Therapy for Rectal Adenocarcinoma
    • Surveillance After Rectal Cancer Treatment
    • Management of Local Recurrences
    • Short-Term Complications - Anastomotic
    • Short-Term Complications - Urinary
    • Ostomy Complications and Management
    • Long-Term Complications – Bowel Dysfunction
    • Long-Term Complications - Sexual Dysfunction and Its Management
    • Parastomal and Perineal Hernias
    • Impact of Postoperative Complications On Oncologic Outcomes
    • Course Complete
    • Final Assessment
Grapherence® [↑5]
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Related Topics

  • Short-Term Complications - Urinary
  • Management of Rectal Cancer
  • Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer
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