Total mesorectal excision (TME)
The standard rectal cancer operation: the rectum is removed together with its surrounding fatty envelope (the mesorectum) in one intact package, which is where local recurrences used to come from.
Introduced by Bill Heald in the 1980s, TME cut local recurrence from 20-30% to under 10% and remains the technical benchmark. Low anterior resection preserves the anal sphincter with an anastomosis (often with a temporary ileostomy); abdominoperineal resection is needed when the tumour involves the sphincter. Robotic and transanal TME are alternatives in narrow pelvises. Total neoadjuvant therapy and watch-and-wait for complete responders aim to avoid TME altogether in selected patients.
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