Total mesorectal excision (TME) in the treatment of rectal cancer

Abstract

Rectal cancer remains one of the most common malignancies in many countries. For decades the "golden standard" treatment for rectal cancer was abdomino-perineal excision (APE) based on Miles' concept of rectal cancer spreading. This conventional surgery (manual or blind dissection) has been associated with local recurrence rates of 20 to 45% and a five-year disease-free survival rate of some 50%. A new era for rectal surgery started in 1982 when Heald introduced the total mesorectum excision technique (TME). From this time we have seen great changes in surgical results for rectal cancer. Patients undergoing only surgical treatment in the form of TME, local recurrence rates were between 3% and 8% and five-year disease-free survival rates were up to 85%. The main technical distinction between TME and conventional surgery is the use of sharp instrument dissection under direct vision, following a defined plane between the visceral and the parietal layers of the pelvic fascia. The TME technique has now been well accepted worldwide due to its excellent results in lowering the rate of local recurrence and successful overall survival after rectal surgery We postulate that the TME technique should be the standard procedure in rectal cancer surgery in Poland.