Total and Tailored Mesorectal Excision for Rectal Cancer: Origins, Evolution, and Misconceptions

SUMMARY: TME, generally interpreted as total mesorectal excision, has been adopted globally as standard of care in rectal cancer. TME originated from a 1982 publication, though neither title nor content implied that total was needed for all. The paper stated that patients with upper rectal cancer could have mesorectal trans-section, tailored to the individual patient. Nevertheless, the concept figure suggested total mesorectal excision with a denuded rectal stump, which could result in higher anastomotic leakage rates. The current update reports that the “T” represents “Total”, or “Tailored “mesorectal excision. The basic principles of “The TME concept” revolve around precision surgery for both distal and circumferential, cancer margin clearance.