Total mesorectal excision

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Total mesorectal excision (TME) is a standard technique for treatment of colorectal cancer, first described in 1982 by Professor Bill Heald at the UK's Basingstoke District Hospital. [1] [2] A significant length of the bowel around the tumour is removed, and the removed lymph system scrutinised for cancerous activity (see lymphadenectomy). It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch.

TME has become the "gold standard" treatment for rectal cancer in the West.[3]

An occasional side effect of the operation is the formation and tangling of fibrous bands from near the site of the operation with other parts of the bowel. These can lead to bowel infarction if not operated on.

TME results in a lower recurrence rate than traditional approaches and a lower rate of permanent colostomy. Postoperative recuperation is somewhat increased over competing methods. When practiced with diligent attention to anatomy there is no evidence of increased risk of urinary incontinence or sexual dysfunction.[4] However, there can be partial fecal incontinence and/or "clustering"--a series of urgent trips to the toilet separated by a few minutes, each trip producing only a very small yield.[5]

It is usually combined with neoadjuvant radiotherapy.


  1. ^ Heald, RJ; et al. (1982). "The mesorectum in rectal cancer surgery-the clue to pelvic recurrence?". Br J Surg. John Wiley & Sons, New Jersey. 69: 613–616. doi:10.1002/bjs.1800691019. 
  2. ^ "UK 'missing out' on life-saving surgery". BBC News. 2000-07-06. Retrieved 2011-02-24. 
  3. ^ Steele, RJC (1999). "Anterior resection with total mesorectal excision". J.R.Coll.Surg.Edinb. Royal College of Surgeons, Edinburgh. 44: 40–45. doi:10.1097/01.sla.0000133185.23514.32. PMC 1356402free to read. PMID 15273550. 
  4. ^ Ridgway, Paul F; Darzi, Ara W (2003). "The Role of Total Mesorectal Excision in the Management of Rectal Cancer" (pdf). Cancer Control. 10 (3): 205–211. PMID 12794618. 
  5. ^