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. 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. It is usually combined with neoadjuvant radiotherapy.