An Overview of Operative Steps and Surgical Technique

Abstract

The curative treatment of rectal cancer is fundamentally surgical, accompanied or not by perioperative chemoradiotherapy. This surgery is known as total mesorectal excision (TME) and implies the complete removal of the tumour and mesorectum. The quality of the resection is a strong predictor of survival and recurrence, as the radial spread of cancer cells is resected entirely with the complete removal of the mesorectum.

TME was initially performed by an open fashion, although minimally invasive surgery proved benefits and was accepted as an alternative approach. Nevertheless, obtaining optimal specimens in patients with difficult anatomy (obese patients, with narrow pelvises or low rectal tumours) is challenging even for very experienced colorectal surgeons. To overcome this problem, new surgical methods such as the transanal total mesorectal excision (taTME) have been developed. Despite the current extension to different pelvic surgical pathologies, rectal cancer is still the most commonly treated disease by a transanal approach. TaTME allows for an easier low pelvis dissection, and improved TME specimens might be obtained. However, it is still a technically demanding procedure that requires appropriate training. The surgical community has embraced taTME because of its enormous potential, but consistency in surgical technique is necessary for its quality assurance. This chapter provides the technical details of the technique, aiming to contribute to a safe expansion.

Supported by: No sources of funding to disclose.