SURGERY OF RECTAL-CARCINOMA - STATUS 1997

The rectum and mesorectum are enclosed in a fascial sheath, the fascia propria, and represent an anatomical entity of abdominal origin. This package is a well-known anatomical and oncological base for radical r ectal cancer excision. It is at present under discussion again under n ew aspects: -The surgical and oncological quality of rectal cancer exc ision is largely surgeon-dependent. -Modern rectal surgery is refined, with sharp, very precise dissection respecting the relevant fascial p lanes, identifying and protecting the autonomous pelvic nerves and ach ieving radical locoregional tumor clearance, thus virtually eliminatin g the serious problem of pelvic recurrence. In this overview the conce pt of total mesorectal excision (TME) is explained and open questions are discussed. It remains to be determined whether a refined and anato mically precise operative technique or the oncologic concept of TME ar e of primary importance, and also whether patient selection influences the results to some degree.