What are alternative surgical approaches to total mesorectal excision (TME)?

Updated: Feb 16, 2021
  • Author: Nanda Kishore Maroju, MRCS, MS, MBBS, DNB; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Nerve-oriented mesorectal excision (NOME) is described as a technique wherein autonomic pelvic nerves serve as landmarks for a standardized navigation along fascial planes. Proponents of this technique claim that it achieves high-quality mesorectal specimens and a high rate of preservation of autonomic nerve function. [5]

TME can also be performed laparoscopically, and excellent long-term outcomes have been reported. [6] A 2014 Cochrane review suggested that survival and recurrence rates are similar to those for the equivalent open procedure, though the evidence was not yet sufficiently precise to rule out the possibility that one approach may be superior to the other. [7]  Robot-assisted approaches have been described as well and found to be safe and effective. [8, 9, 10]

Transanal approaches to TME have been the subject of considerable interest. So far, such approaches appear to be safe and feasible in the treatment of rectal cancer. [11, 12, 13, 14]  A 2017 study by Marks et al (N = 373; mean follow-up, 5.5 years) reported good long-term outcomes with a transanal approach to TME. [15]  A meta-analysis by Gachabayov et al found that transanal TME of rectal cancer did not improve histopathology metrics and complication rates as compared with robotic TME. [16]


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