Surgical Technique and Difficult Situations from Markus W. Buechler (Conventional)

The current gold standard for oncological resection of tumors derived from the middle and lower rectum remains the total mesorectal excision (TME). In contrast, tumors derived from the upper third are often treated with a partial mesorectal excision (PME). In cases where a PME is planned, care must be taken to ensure a minimum distance of 5 cm between tumor and excision margin. In addition, the bordering lamella of the entire resected tissue must be excised without damage, and a coning of the perirectal tissue should be avoided. This is of particular importance because lymph node metastases extending up to 5 cm distal to the lower border of the tumor have been described (Heald). In cases where a deep anterior rectum resection with complete removal of the mesorectal tissue is performed, a tumor-free border at the excision margins is adequate and allows sphincter function to be preserved.