What is TME surgery?

Total mesorectal excision (TME) is a surgical procedure to remove cancer from the end of the anal area (rectum).
Total mesorectal excision (TME) is a surgical procedure to remove cancer from the end of the anal area (rectum).

Total mesorectal excision (TME) is a type of procedure to remove cancer from the end of the anal area (rectum). In this procedure, the surgeon removes the part of the rectum that contains cancer and some healthy tissue on either side. 

They also remove the fatty tissue (mesorectum) around the rectum, which contains the blood vessels and lymph nodes. Removing the mesorectum reduces the risk of any cancer being left behind. This procedure can sometimes be used for early-stage cancers that are higher in the rectum and not accessible by other procedures. 

A specially designed magnifying scope is inserted through the anus and into the rectum. This allows the surgeon to remove the cancerous part with greater precision and accuracy. 

When is total mesorectal surgery recommended?

Total mesorectal excision (TME) surgery is recommended for patients who have cancers in the middle and lower area of the rectum. It is now considered the gold standard procedure for removing tumors in the middle and lower areas of the rectum.

How is a TME surgery performed?

Total mesorectal excision (TME) is performed under general anesthesia with or without an epidural painkiller. The procedure is performed by a specially designed instrument called a laparoscope. 

The rectum and colon are freed up from the surrounding attachments so that the diseased segment can be safely removed along with some of the fatty tissue that carries the blood vessels and lymph drainage to the bowel.

The ends of the intestine are then reattached. At the end of the operation, the abdominal wall is stitched up and then the skin is closed, usually with absorbable sutures.

The rectal procedure has three different methods of approach:

  • Anterior resection or TME: Anterior resection is usually used for cancers in the upper and middle parts of the rectum (close to the colon). After the cancer is removed from the area, the surgeon rejoins the two open ends of the intestine. Some people may need an artificial opening called a stoma after this operation. This artificial opening is usually closed after a few months.
  • Colo-anal and J pouch surgery: This method may be used for removing cancers in the lower rectum. The surgeon removes the entire rectum and attaches the intestine to the anus. Sometimes, the surgeon makes a pouch (called a J pouch) from part of the colon, before joining it to the anus. The pouch acts like a new rectum and stores stools until it is convenient to pass them. Usually, the patients need an artificial opening for this procedure, which is later closed upon the patient’s recovery.
  • Abdominoperineal resection (APR): This method is usually used for cancers that are very low in the rectum (near to the anus). To remove all cancers, the surgeon needs to remove the rectum and anus. The patient might have a permanent artificial opening for this procedure because the anal area is completely removed.

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What are the risks involved in TME surgery?

Total mesorectal excision (TME) procedure is associated with the following risks:

  • Anesthesia complications such as headache, drowsiness, and vomiting
  • Bleeding
  • Pain
  • Infection in the surgical area
  • Leak from the joined area
  • Blood clot in the veins or lungs
  • Impaired rectum function
  • Stigma due to the presence of an artificial opening

What is the outcome of TME surgery?

Patients who have rectal cancer that is confined to the lower two-third of the rectum are generally considered good candidates for a total mesorectal excision (TME) surgery. Patients are usually discharged within a week after the procedure. Patients typically have a five-year survival rate with fewer complications after a TME procedure.

What is complete mesocolic excision (CME)?

Complete mesocolic excision (CME) is the surgical treatment of colon (large intestine) cancer. The goal of this procedure is to remove the affected large intestine along with some healthy tissue on either side. 

Usually, the surgeon also removes the fatty tissue (mesocolon) around the colon, which contains the blood vessels and lymph nodes. Removing the mesocolon reduces the risk of any cancer being left behind. 

This procedure is performed under a specially designed laparoscope under general anesthesia. CME adopts the same principle as total mesorectal excision (TME). 

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Medically Reviewed on 7/29/2020
References
"Total Mesorectal Excision (TME)"

Medscape Medical Reference
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