Total mesorectal excision with autonomic nerve preservation: “Optimized surgery”

Abstract

The superiority of total mesorectal excision (TME) for rectal cancer in reducing the incidence of local recurrence and improving long term survival compared to conventional blunt rectal dissection is well established. Impotence and other complications due to autonomic nerve injury are among the consequences of operations for treatment of rectal cancer. Sharp dissection along the parietal pelvic fascia where the parasympathetic nerves are located significantly reduces the incidence local recurrence. Autonomic nerve preservation during pelvic sidewall dissections is discussed in this chapter. Role of tumor specific TME, intraoperative nerve monitoring and importance of obtaining negative circumferential resection margin is discussed as well.