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.
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.
They are pubocervical fascia, rectovaginal fascia, Waldeyer fascia, rectosacral fascia, mesorectum
, paracolpium, pubourethral ligament, cardinal ligament, uterosacral ligament, and umbilical ligament.
However, with the introduction of new operative procedures for total mesorectal excision (TME), the envelope of lymphovascular fatty tissue and the mesorectum
 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.
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.