{"entity":{"id":"total-mesorectal-excision","kind":"term","name":"Total mesorectal excision (TME)","aka":["mesorectal excision","low anterior resection","anterior resection","TME surgery"],"tldr":"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.","summary":"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.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Total_mesorectal_excision","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Total_mesorectal_excision"},{"label":"NICE NG151: colorectal cancer, recommendations","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations"},{"label":"Macmillan: surgery for rectal cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-to-remove-rectal-cancer"},{"label":"Bowel Cancer UK: stomas","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/treatment/surgery/stomas/"},{"label":"Heald, Br J Surg 1982: the mesorectum in rectal cancer surgery, the clue to pelvic recurrence?","url":"https://doi.org/10.1002/bjs.1800691019"},{"label":"Quirke, Lancet 1986: local recurrence of rectal adenocarcinoma due to inadequate surgical resection (52 specimens sliced transversely)","url":"https://doi.org/10.1016/s0140-6736(86)92612-7"},{"label":"Nagtegaal and Quirke, J Clin Oncol 2008: what is the role for the circumferential margin in the modern treatment of rectal cancer? (more than 17,500 patients)","url":"https://doi.org/10.1200/jco.2007.12.7027"}],"tags":[],"related":["abdominoperineal-resection","organ-preservation","total-neoadjuvant-therapy"],"cancers":["colorectal","rectal-cancer"],"sections":["surgery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["circumferential-resection-margin","watch-and-wait-rectal-cancer"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Rectal cancer: NICE NG151's table for early rectal cancer compares transanal excision, endoscopic submucosal dissection and total mesorectal excision on the points a patient weighs, namely whether bowel is resected (with more impact on sexual and bowel function), whether a stoma is possible, the usual hospital stay of 5 to 7 days against 1 to 2, and external scarring. Its listed complications include adhesions, anastomotic leak, anastomotic stricture, bleeding, incisional hernia, injury to neighbouring structures, pelvic abscess and urinary retention. NICE also says hospitals performing major resection for rectal cancer should perform at least 10 each year and individual surgeons at least 5.","Where it came from: Heald found microscopic deposits of adenocarcinoma in the mesorectum several centimetres below the visible lower edge of the tumour, left behind by orthodox anterior resection, and removed the whole envelope instead; the first 50 curative operations had no pelvic or staple-line recurrence at two years (Br J Surg 1982).","Why the pathologist's report matters as much as the operation: tumour within 1 mm of the circumferential margin predicts local recurrence, distant metastases and shorter survival, and predicts local recurrence more strongly after preoperative radiotherapy than without it (Nagtegaal and Quirke 2008)."],"category":"Procedures"},"route":"/terms/total-mesorectal-excision/","neighbours":{"term":[{"id":"abdominoperineal-resection","kind":"term","name":"Abdominoperineal resection","route":"/terms/abdominoperineal-resection/"},{"id":"circumferential-resection-margin","kind":"term","name":"Circumferential resection margin (rectal cancer)","route":"/terms/circumferential-resection-margin/"},{"id":"colectomy","kind":"term","name":"Colectomy","route":"/terms/colectomy/"},{"id":"living-with-a-stoma-bowel-cancer","kind":"term","name":"Living with a stoma after bowel cancer surgery","route":"/terms/living-with-a-stoma-bowel-cancer/"},{"id":"low-anterior-resection-syndrome","kind":"term","name":"Low anterior resection syndrome (LARS)","route":"/terms/low-anterior-resection-syndrome/"},{"id":"organ-preservation","kind":"term","name":"Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)","route":"/terms/organ-preservation/"},{"id":"total-neoadjuvant-therapy","kind":"term","name":"Total neoadjuvant therapy (TNT, rectal cancer)","route":"/terms/total-neoadjuvant-therapy/"},{"id":"watch-and-wait-rectal-cancer","kind":"term","name":"Watch and wait after chemoradiotherapy for rectal cancer","route":"/terms/watch-and-wait-rectal-cancer/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"colorectal-micropapillary-carcinoma","kind":"cancer","name":"Micropapillary adenocarcinoma of the colon and rectum","route":"/cancers/colorectal-micropapillary-carcinoma/"},{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"paper":[{"id":"paper-swedish-rectal-cancer-trial-preoperative-radiotherapy-nejm-1997","kind":"paper","name":"Improved survival with preoperative radiotherapy in resectable rectal cancer (Swedish Rectal Cancer Trial)","route":"/key-papers/paper-swedish-rectal-cancer-trial-preoperative-radiotherapy-nejm-1997/"},{"id":"paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021","kind":"paper","name":"Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23)","route":"/key-papers/paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021/"},{"id":"paper-garcia-aguilar-opra-organ-preservation-jco-2022","kind":"paper","name":"Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)","route":"/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/"},{"id":"paper-kapiteijn-dutch-tme-preoperative-radiotherapy-nejm-2001","kind":"paper","name":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial)","route":"/key-papers/paper-kapiteijn-dutch-tme-preoperative-radiotherapy-nejm-2001/"},{"id":"paper-sebag-montefiore-cr07-preoperative-radiotherapy-lancet-2009","kind":"paper","name":"Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)","route":"/key-papers/paper-sebag-montefiore-cr07-preoperative-radiotherapy-lancet-2009/"},{"id":"paper-esmo-rectal-cancer-guideline-ann-oncol-2017","kind":"paper","name":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","route":"/key-papers/paper-esmo-rectal-cancer-guideline-ann-oncol-2017/"},{"id":"paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021","kind":"paper","name":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)","route":"/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/"},{"id":"paper-heald-mesorectum-rectal-cancer-surgery-br-j-surg-1982","kind":"paper","name":"The mesorectum in rectal cancer surgery: the clue to pelvic recurrence?","route":"/key-papers/paper-heald-mesorectum-rectal-cancer-surgery-br-j-surg-1982/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/colorectal-roadmap/"}],"idea":[{"id":"idea-crc-organ-preservation-randomised-in-pmmr-rectal","kind":"idea","name":"Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint","route":"/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/"}],"trial":[{"id":"opra","kind":"trial","name":"OPRA","route":"/trials/opra/"},{"id":"prospect","kind":"trial","name":"PROSPECT (Alliance N1048)","route":"/trials/prospect/"}]}}