Total mesorectal excision
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. A significant length of the bowel around the tumour is removed, as is the surrounding tissue up to the plane between the mesorectum and the presacral fascia (Heald's "holy plane"). Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and hypogastric nerves. It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of perforation or leakage.
TME has become the "gold standard" treatment for rectal cancer in the West.
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. 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.
- Heald, R. J.; Husband, E. M.; Ryall, R. D. H. (1982). "The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?". British Journal of Surgery. 69 (10): 613–6. doi:10.1002/bjs.1800691019. PMID 6751457.
- "UK 'missing out' on life-saving surgery". BBC News. July 6, 2000. Retrieved December 14, 2016.
- Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med 1988;81:503–80
- Steele, R. J. (1999). "Anterior resection with total mesorectal excision". Journal of the Royal College of Surgeons of Edinburgh. 44 (1): 40–5. PMID 10079668.
- Ridgway, Paul F.; Darzi, Ara W. (2003). "The role of total mesorectal excision in the management of rectal cancer" (PDF). Cancer control. 10 (3): 205–11. PMID 12794618.
- Chen, Tina Yen-Ting; Wiltink, Lisette M.; Nout, Remi A.; Meershoek-Klein Kranenbarg, Elma; Laurberg, Søren; Marijnen, Corrie A.M.; Van De Velde, Cornelis J.H. (2015). "Bowel Function 14 Years After Preoperative Short-Course Radiotherapy and Total Mesorectal Excision for Rectal Cancer: Report of a Multicenter Randomized Trial". Clinical Colorectal Cancer. 14 (2): 106–14. doi:10.1016/j.clcc.2014.12.007. PMID 25677122.
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