Abstract
While the treatment of rectal cancer is multimodal, above all, a proper oncological
resection is critical. The surgical management of rectal cancer has substantially
evolved over the past 100 years, and continues to progress as we seek the best treatment.
Rectal cancer was historically an unsurvivable disease, with poor understanding of
the embryological planes, lymphatic drainage, and lack of standardized technique.
Major improvements in recurrence, survival, and quality of life have resulted from
advances in preoperative staging, pathologic assessment, the development and timing
of multimodal therapies, and surgical technique. The most significant contribution
in advancing rectal cancer care may be the standardization and widespread implementation
of total mesorectal excision (TME). The TME, popularized by Professor Heald in the
early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all
associated lymph nodes through the avascular embryologic plane, has shown universal
reproducible reductions in local recurrence and improvement in disease-free and overall
survival. Widespread education and training of surgeons worldwide in the TME have
significantly impact outcomes for rectal cancer surgery, and the procedure has become
the gold standard for curative resection of rectal cancer. In this article, we discuss
the evolution of the standard abdominal approach to the TME, with emphasis on the
history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical
evolution.
Keywords
rectal cancer - total mesorectal excision (TME) - transanal total mesorectal excision
(TaTME) - holy plane - mesorectal fascia
