The role of total mesorectal excision in rectal cancer surgery

A subtotal mesorectal excision with straight colorectal anastomosis should be done when the resection line is located 7 cm or more from the anal verge with a distal margin to the tumour of at least 3 cm. Subtotal TME combined with closure of the rectum and a colostomy (Hartmann's procedure) is performed at any level provided it is oncologically acceptable. TME with restorative surgery by a pouch-anal anastomosis is used for lower lesions not allowing an anastomosis at least 7 cm from the anal verge. TME with a low Hartmann's procedure is performed in patients with disseminated disease, other high risk patients, and when the anal sphincter function is inadequate. Abdomino-perineal resection (with the TME technique) is performed when the anal canal is infiltrated by tumour. TME is indicated in all rectal cancers which can be palpated.