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Clin Colon Rectal Surg 2015; 28(01): 028-037
DOI: 10.1055/s-0035-1545067
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Changing the Way We Manage Rectal Cancer—Standardizing TME from Open to Robotic (Including Laparoscopic)

Katrina L. Weaver
1   Department of Surgery, University of South Alabama, Mobile, Alabama
,
Leander M. Grimm Jr.
2   Division of Colon and Rectal Surgery, University of South Alabama, Mobile, Alabama
,
James W. Fleshman
3   Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
› Author Affiliations
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Publication History

Publication Date:
18 February 2015 (online)

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Abstract

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.

Keywords

rectal cancer - total mesorectal excision - circumferential margin - single-incision laparoscopic surgery - tumor-specific mesorectal excision
 

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