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Changing the Way We Manage Rectal Cancer-Standardizing TME from Open to Robotic
(Including Laparoscopic)
#MMPMID25733971
Weaver KL
; Grimm LM Jr
; Fleshman JW
Clin Colon Rectal Surg
2015[Mar]; 28
(1
): 28-37
PMID25733971
show ga
Standardizing total mesorectal excision (TME) has been a topic of interest since
1979 when Professor Richard J. Heald first described TME and a new approach to
rectal cancer. The procedure is optimized only if every one of the relevant
factors is tackled with precise attention to detail, so that the preoperative,
operative, and postoperative practice is standardized completely. The same
concept of TME standardization applies today regardless of technique chosen, that
is, open laparoscopic, single-incision laparoscopic surgery, or robotic. This
article reviews the relevant operative factors in performing a quality TME,
looking at both the oncologic and nononcologic advantages and disadvantages. It
supports TME as the standard of care in obtaining a negative circumferential
margin for mid and lower-third rectal cancers, and discusses the role of
tumor-specific mesorectal excision for upper-third rectal cancers. It discusses
the new options and challenges each operative technique holds, and identifies the
same standardized principles each must obey to provide the highest quality of
oncologic resection. The operative documentation of these critical features from
diagnostic workup to pathological reporting is also emphasized.
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