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Bill Heald noticed cancer cells hiding in the fatty envelope around the rectum, centimetres below the tumour, and started removing the whole envelope intact. Pelvic recurrence fell from a quarter of patients to almost none.
Heald, Husband and Ryall described five cases in which minute foci of adenocarcinoma were demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer; in two of these there was no other evidence of lymphatic spread. In orthodox anterior resection much of this tissue remains in the pelvis, and the authors suggested that these foci might cause suture-line or pelvic recurrence.
Total excision of the mesorectum had therefore been carried out as part of over 100 consecutive anterior resections. Fifty of these, classified as curative or conceivably curative, had been followed for over two years with no pelvic or staple-line recurrence.
The single largest improvement in rectal cancer outcomes came from a change in surgical technique, not a drug. Every radiotherapy trial since has had to show it adds something on top of a properly performed total mesorectal excision.
Shares Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Total mesorectal excision (TME), Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, Robotic & minimally invasive surgery and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer and the tag colorectal-evidence.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Colorectal cancer and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer, Colorectal cancer and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer, Colorectal cancer and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Rectal cancer, Colorectal cancer and the tag colorectal-evidence.