The TME technique involves removal of the rectum and the complete perirectal soft tissue envelope (the
mesorectum) using sharp dissection, under direct vision, in the plane between the visceral and parietal pelvic fascia.
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").
Performing a complete resection of rectum and
mesorectum necessitates a meticulous dissection within the embryologic planes, where rectum is closely located to vital vessels, nerves and adjacent organs.
The
mesorectum in rectal cancer surgery-the clue to pelvic recurrence?
Tumor invasion greater than 15 mm (referring to T3d) is rare, because the Chinese
mesorectum is generally thinner than the European and American
mesorectums.
(11) Therefore, a tumor in the mid-rectum, such as demonstrated in the case presentation, can grow laterally and posteriorly into the
mesorectum but also anteriorly to its serosa (peritoneum).
Dissection is conveyed upwards along the posterior part of the
mesorectum toward the IMA, taking consideration not to break the fascia propria of the rectum and avoiding damage to the superior hypogastric nerves.
However, with the introduction of new operative procedures for total mesorectal excision (TME), the envelope of lymphovascular fatty tissue and the
mesorectum [3] was completely excised, leading to a significant decrease in the local recurrence rate of colorectal cancer [4, 5].
(1,2) This may be explained by the anatomy of the distal rectum, which is covered by less
mesorectum, resulting in earlier tumour invasion of surrounding structures compared to the more proximal rectum.
Mesorectum is fat pad surrounding the rectum, and contains lymphatics and lymph nodes, separating it from surrounding structures even when tumour breeches the muscular layer.
He discussed in detail the quality of the
mesorectum why it is important and why should one do TME.