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Total Mesorectal Excision (TME)

Gold-standard oncological technique that removes the mesorectum en bloc through sharp dissection in rectal cancer.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Total Mesorectal Excision (TME)?

Total mesorectal excision (TME) is the gold-standard oncological technique in rectal cancer surgery, defined by sharp dissection in the avascular embryologic plane and en-bloc removal of the entire mesorectum with intact mesorectal fascia. It was described by Heald in 1982.

The dissection follows the so-called holy plane, allowing complete removal of the fascial envelope containing all mesorectal lymph nodes and tumor deposits.

TME has reduced rectal cancer local recurrence from approximately 25 percent to 5 to 8 percent. Nerve preservation maintains urogenital function in most patients. Specimen quality is graded with the Quirke macroscopic score.

Symptoms

Histologically confirmed rectal adenocarcinoma
Mid- and lower-third rectal tumors
Locally advanced T3 to T4 tumors after neoadjuvant therapy
Lymph node-positive rectal cancer
Patients without synchronous distant disease
Candidates for R0 resection
Patients eligible for sphincter-preserving surgery
Intact mesorectal fascia on imaging

Risk Factors

Hypogastric nerve injury with sexual dysfunction
Anastomotic leak in 5 to 15 percent
Ureteric injury
Presacral hemorrhage
Need for abdominoperineal resection
Narrow male pelvis and obesity
Tissue stiffness after neoadjuvant radiotherapy
Positive circumferential resection margin

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Signs of anastomotic leak — fever and abdominal pain
  • Enteric content in surgical drains
  • Findings of presacral abscess
  • Urinary retention or new sexual dysfunction
  • Lower extremity edema
  • Rectal bleeding

Treatment Methods

01
Neoadjuvant chemoradiotherapy in locally advanced T3 to T4 or node-positive disease
02
Preoperative MRI assessment of the mesorectal fascia
03
Laparoscopic, robotic, or open approach
04
Sharp dissection in the presacral avascular plane
05
Preservation of hypogastric and pelvic autonomic nerves
06
Decision between low anterior resection and abdominoperineal resection
07
Diverting loop ileostomy in selected patients
08
Pathological grading of specimen quality (Quirke score)

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.