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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.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
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.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.
The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.
The document behind the MRI-first rectal cancer pathway used across Europe and the UK; the total neoadjuvant therapy trials (RAPIDO, PRODIGE 23, OPRA) that came after it are the main reason an update was needed.
The trial that made preoperative rather than postoperative radiotherapy the UK standard, and the one whose circumferential resection margin pathology protocol, led by Quirke, became the quality measure for rectal surgery worldwide.
The modern basis for offering short-course radiotherapy selectively: it buys local control, not survival, so the decision turns on the predicted recurrence risk from MRI against the long-term bowel and sexual morbidity of pelvic irradiation.
The origin of short-course preoperative radiotherapy, still the standard schedule across northern Europe and the backbone of the RAPIDO regimen 24 years later.
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 versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Total neoadjuvant therapy (TNT, rectal cancer), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation).
Shares Abdominoperineal resection, Low anterior resection syndrome (LARS), Living with a stoma after bowel cancer surgery, Organ preservation (watch-and-wait, bladder-sparing, larynx preservation).
Shares OPRA, Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, 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.
Shares Watch and wait after chemoradiotherapy for rectal cancer, OPRA, Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation).
Shares Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, 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.
Shares Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, 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.
Shares Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), 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.
Shares Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, 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.