Total mesorectal excision: fascial surgery or compartment surgery

Abstract

Total mesorectal excision (TME) improves the prognosis of patients with rectal cancer (RC) and now is being established as the gold standard for RC surgery. Local spread of tumor is thought to be contained within a defined intact visceral mesorectal fascial envelope. Therefore, surgical dissection along correct plane with complete mesorectum excision is the essence of TME. Recent literatures stated that TME with the guidance of membrane anatomy could improve tumor radicality and reduce genitourinary dysfunction. But TME remains the object of ongoing controversy. In fact, the conventional function anatomy can′t provide theoretical support for TME. Observations of the anatomical studies found that Holy Plane was unlikely to become an almost impenetrable barrier to the spread of carcinoma and it didn′t ensure complete excision of mesorectum along the correct surgical plane. Compartment theory based on the ontogenetic anatomy suggested that tumors were always locally confined to a compartment derived from a common embryologic origin (primordium) for a relatively long phase. The potential reasons lie in that tumor propagation is primarily suppressed at the compartment borders. The compartment model of tumor spread provides explanations for TME which excise the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles of tumor radicality. Key words: Rectal neoplasms; Total mesorectal excision; Compartment; Fascia; Anatomy